Provider Demographics
NPI:1114956356
Name:FISK, HENRY (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:
Last Name:FISK
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 1:236 BACK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:ME
Mailing Address - Zip Code:04730
Mailing Address - Country:US
Mailing Address - Phone:207-532-6777
Mailing Address - Fax:
Practice Address - Street 1:201 HOULTON RD
Practice Address - Street 2:
Practice Address - City:DANFORTH
Practice Address - State:ME
Practice Address - Zip Code:04424-0044
Practice Address - Country:US
Practice Address - Phone:207-448-2347
Practice Address - Fax:207-448-2313
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME009190208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MED03756Medicare UPIN