Provider Demographics
NPI:1477649176
Name:FISHER, GEORGE EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:EDWARD
Last Name:FISHER
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 1:5751 NORTH BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141
Mailing Address - Country:US
Mailing Address - Phone:215-843-0672
Mailing Address - Fax:215-843-0674
Practice Address - Street 1:5751 NORTH BROAD STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141
Practice Address - Country:US
Practice Address - Phone:215-843-0672
Practice Address - Fax:215-843-0674
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD061558L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30010670OtherKEYSTONE MERCY
PA34699 MD061558LOtherHEALTHPARTNERS
PA954658OtherBCBS (IBC)
PAHMO2590672OtherAETNA US HEALTHCARE
34699OtherKEYSTONE MERCY HEALTH PAR
PA30010670OtherKEYSTONE MERCY
34699OtherKEYSTONE MERCY HEALTH PAR
G61513Medicare UPIN