Provider Demographics
NPI:1407921372
Name:FISHER, ALLEN CRAIG (DO)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:CRAIG
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 CRAIN HWY N STE 5A
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-9307
Mailing Address - Country:US
Mailing Address - Phone:410-766-7016
Mailing Address - Fax:
Practice Address - Street 1:1414 CRAIN HWY N STE 5A
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-9307
Practice Address - Country:US
Practice Address - Phone:410-766-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2008-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0052510207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0100775OtherUNITED HEALTHCARE
2330992OtherAETNA HMO
280964OtherALLIANCE
P13753OtherCAREFIRST POS
7729015OtherAETNA PPO, EPO
OF24ACOtherCAREFIRST BCBS
1138450OtherFIRST HEALTH
W4870001OtherBLUE CHOICE AND FEP
7729015OtherAETNA PPO, EPO
OF24ACOtherCAREFIRST BCBS