Provider Demographics
NPI:1073704847
Name:FISHBURNE, FRANCIS J (PHD)
Entity Type:Individual
Prefix:DR
First Name:FRANCIS
Middle Name:J
Last Name:FISHBURNE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:FRANCIS
Other - Middle Name:J
Other - Last Name:FISHBURNE
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2919 ELMESMEADE CT
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-1746
Mailing Address - Country:US
Mailing Address - Phone:240-353-8153
Mailing Address - Fax:703-938-7885
Practice Address - Street 1:10401 OLD GEORGETOWN RD
Practice Address - Street 2:SUITE208
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1911
Practice Address - Country:US
Practice Address - Phone:240-353-8153
Practice Address - Fax:703-938-7885
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01022103G00000X
SC1012103G00000X
VA0810001099103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist