Provider Demographics
NPI:1164462396
Name:FISCHER, PETER LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:LAWRENCE
Last Name:FISCHER
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 1:1788 MARY SHELDON DR SW
Mailing Address - Street 2:
Mailing Address - City:SHALLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28470-6091
Mailing Address - Country:US
Mailing Address - Phone:910-386-9106
Mailing Address - Fax:
Practice Address - Street 1:1788 MARY SHELDON DR SW
Practice Address - Street 2:
Practice Address - City:SHALLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28470-6091
Practice Address - Country:US
Practice Address - Phone:910-386-9106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78706207L00000X
NC200801254207L00000X
MI4301102113207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A787060Medicaid
CA00A787060Medicaid
NC2022954Medicare PIN