Provider Demographics
NPI:1235150756
Name:FISCHER, PETER A (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
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 1:200 COPELAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-1225
Mailing Address - Country:US
Mailing Address - Phone:508-339-4144
Mailing Address - Fax:508-261-9940
Practice Address - Street 1:200 COPELAND DR
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-1225
Practice Address - Country:US
Practice Address - Phone:508-339-4144
Practice Address - Fax:508-261-9940
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74937207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ12977OtherMABC
43614OtherFALLON
MA3098800Medicaid
000000028126OtherBMC HEALTHNET
405734OtherRIBC
IM-B10235901OtherCIGNA
65743OtherHPHC
RH-B10235906OtherCIGNA
074937OtherTUFTS
3200141OtherUHC
405734OtherRIBC
MAF38130Medicare UPIN