Provider Demographics
NPI:1407936198
Name:FISHMANN, ANDREW JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAY
Last Name:FISHMANN
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 1:1245 WILSHIRE BLVD STE 503
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4805
Mailing Address - Country:US
Mailing Address - Phone:213-977-4979
Mailing Address - Fax:213-977-0544
Practice Address - Street 1:1245 WILSHIRE BLVD STE 503
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4805
Practice Address - Country:US
Practice Address - Phone:213-977-4979
Practice Address - Fax:213-977-0544
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44744207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G4477440Medicaid
CAWG44744BMedicare ID - Type Unspecified