Provider Demographics
NPI:1043298250
Name:FISHER, PHILLIP H (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:H
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7640 W. SYLVANIA
Mailing Address - Street 2:SUITE K
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560
Mailing Address - Country:US
Mailing Address - Phone:419-517-1001
Mailing Address - Fax:419-517-1021
Practice Address - Street 1:7640 W. SYLVANIA
Practice Address - Street 2:SUITE K
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560
Practice Address - Country:US
Practice Address - Phone:419-517-1001
Practice Address - Fax:419-517-1021
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35. 042176207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0418033Medicaid
OHP00147852OtherMEDICARE RAILROAD
OH0418033Medicaid
OHA78895Medicare UPIN