Provider Demographics
NPI:1376639021
Name:FISHER, DOROTHY (MD)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 RUSTIC DRIVE
Mailing Address - Street 2:
Mailing Address - City:ESSEX JCT.
Mailing Address - State:VT
Mailing Address - Zip Code:05452
Mailing Address - Country:US
Mailing Address - Phone:820-878-9923
Mailing Address - Fax:
Practice Address - Street 1:15 RUSTIC DRIVE
Practice Address - Street 2:
Practice Address - City:ESSEX JCT.
Practice Address - State:VT
Practice Address - Zip Code:05452
Practice Address - Country:US
Practice Address - Phone:820-878-9923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0420010224207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0VN2616Medicaid
VTVN2616Medicare ID - Type Unspecified
VT0VN2616Medicaid