Provider Demographics
NPI:1447229562
Name:FISHER, MARK DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DONALD
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3090 CLOVERBANK RD
Mailing Address - Street 2:
Mailing Address - City:HAMBURG
Mailing Address - State:NY
Mailing Address - Zip Code:14075-3424
Mailing Address - Country:US
Mailing Address - Phone:716-830-1350
Mailing Address - Fax:716-205-7525
Practice Address - Street 1:1207 DELAWARE AVE STE 490
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14209-1458
Practice Address - Country:US
Practice Address - Phone:716-830-1350
Practice Address - Fax:716-205-7525
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY207389207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02097354Medicaid
NYCC1144Medicare ID - Type Unspecified
NY02097354Medicaid