Provider Demographics
NPI:1083605406
Name:FISHER, OTIS NORWOOD (MD)
Entity Type:Individual
Prefix:DR
First Name:OTIS
Middle Name:NORWOOD
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 13005
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-3005
Mailing Address - Country:US
Mailing Address - Phone:336-274-4285
Mailing Address - Fax:336-268-9062
Practice Address - Street 1:1317 N ELM ST
Practice Address - Street 2:SUITE 1B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1033
Practice Address - Country:US
Practice Address - Phone:336-274-4285
Practice Address - Fax:336-268-9062
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC114792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC70511OtherMEDCOST
NC8932200Medicaid
NC1600270OtherUNITED HEALTHCARE
NC3125OtherPARTNERS
NC32200OtherBLUE CROSS BLUE SHIELD
NC8932200Medicaid
NC32200OtherBLUE CROSS BLUE SHIELD