Provider Demographics
NPI:1073691440
Name:FISHER, DAVID CARL (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CARL
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 1:3805 EDWARDS RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1900
Mailing Address - Country:US
Mailing Address - Phone:513-321-0833
Mailing Address - Fax:513-321-6063
Practice Address - Street 1:3805 EDWARDS RD
Practice Address - Street 2:SUITE 350
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1900
Practice Address - Country:US
Practice Address - Phone:513-321-0833
Practice Address - Fax:513-321-6063
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064603207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2739737Medicaid
OH2739737Medicaid