Provider Demographics
NPI:1245233766
Name:FISCO, JAMES R (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:FISCO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2912 SPRINGBORO W
Mailing Address - Street 2:STE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45439-1674
Mailing Address - Country:US
Mailing Address - Phone:937-297-8996
Mailing Address - Fax:937-885-0702
Practice Address - Street 1:70 REMICK BLVD
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-9168
Practice Address - Country:US
Practice Address - Phone:937-885-0701
Practice Address - Fax:937-885-0702
Is Sole Proprietor?:No
Enumeration Date:2005-05-30
Last Update Date:2014-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004435F207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2202445OtherAETNA
OH000000337888OtherUNICARE
OH0443503OtherHUMANA/CHOICECARE
OH421534506086OtherCARESOURCE
OH080191710OtherRAILROAD MEDICARE
OH000000227888OtherANTHEM
OH0704429Medicaid
OH0102237OtherUNITED HEALTH CARE
OH34004435FOtherMEDICAL LICENSE
OH080191710OtherRAILROAD MEDICARE
OH34004435FOtherMEDICAL LICENSE
OH0102237OtherUNITED HEALTH CARE