Provider Demographics
NPI:1114943461
Name:FISHER, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
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 1:4 HIDDEN POND LN
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1058
Mailing Address - Country:US
Mailing Address - Phone:732-787-2686
Mailing Address - Fax:201-342-1259
Practice Address - Street 1:1 UNIVERSITY OF NEW MEXICO # 106000
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131
Practice Address - Country:US
Practice Address - Phone:505-272-1113
Practice Address - Fax:505-272-1300
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08012400174400000X
NMMD2018-0696174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
I09174Medicare UPIN
NJ099555DSNMedicare ID - Type Unspecified