Provider Demographics
NPI:1013203322
Name:FISCHER, LILA MERRILY (CPM)
Entity Type:Individual
Prefix:MISS
First Name:LILA
Middle Name:MERRILY
Last Name:FISCHER
Suffix:
Gender:F
Credentials:CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:
Mailing Address - City:WEST TISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02575-0106
Mailing Address - Country:US
Mailing Address - Phone:508-939-0404
Mailing Address - Fax:508-693-5685
Practice Address - Street 1:200 RD TO GREAT NECK
Practice Address - Street 2:
Practice Address - City:WEST TISBURY
Practice Address - State:MA
Practice Address - Zip Code:02575-0106
Practice Address - Country:US
Practice Address - Phone:508-939-0404
Practice Address - Fax:508-693-5685
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-24
Last Update Date:2011-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10110005176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife