Provider Demographics
NPI:1124044490
Name:FISHMAN, MINDY CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:CAROL
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:46 CHARTER OAK DR
Mailing Address - Street 2:
Mailing Address - City:NEW CANAAN
Mailing Address - State:CT
Mailing Address - Zip Code:06840-6701
Mailing Address - Country:US
Mailing Address - Phone:203-594-9171
Mailing Address - Fax:203-594-9171
Practice Address - Street 1:46 CHARTER OAK DR
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-6701
Practice Address - Country:US
Practice Address - Phone:203-594-9171
Practice Address - Fax:203-594-9171
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032-715207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F53867Medicare UPIN