Provider Demographics
NPI:1407042005
Name:RICHARD E. FISHBEIN, MD
Entity Type:Organization
Organization Name:RICHARD E. FISHBEIN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:FISHBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-453-4074
Mailing Address - Street 1:PO BOX 1200
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37088-1200
Mailing Address - Country:US
Mailing Address - Phone:615-453-4074
Mailing Address - Fax:615-453-4072
Practice Address - Street 1:1432 W MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-1323
Practice Address - Country:US
Practice Address - Phone:615-453-4074
Practice Address - Fax:615-453-4072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD013323207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0018672Medicaid
3384976Medicare PIN
A40893Medicare UPIN