Provider Demographics
NPI:1083711170
Name:FISHER, DAVID MICHAEL
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MICHAEL
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3673 SOUTHWESTERN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORCHARD PARK
Mailing Address - State:NY
Mailing Address - Zip Code:14127-1740
Mailing Address - Country:US
Mailing Address - Phone:716-662-4827
Mailing Address - Fax:716-662-2969
Practice Address - Street 1:3673 SOUTHWESTERN BLVD
Practice Address - Street 2:
Practice Address - City:ORCHARD PARK
Practice Address - State:NY
Practice Address - Zip Code:14127-1740
Practice Address - Country:US
Practice Address - Phone:716-662-4827
Practice Address - Fax:716-662-2969
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2109341207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02429472Medicaid
NY510464332OtherFIDELIS
NY000527348001OtherBLUE CROSS & BLUE SHIELD
NYBA0153OtherMEDICARE
NY00026381301OtherUNIVERA
NY0911686OtherINDEPENDENT HEALTH
NY510464332OtherEMPIRE
NYP00144320OtherMEDICARE RAILROAD