Provider Demographics
NPI:1477669539
Name:FISHMAN, ROBERT M (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:FISHMAN
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 1:129 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1388
Mailing Address - Country:US
Mailing Address - Phone:413-538-5620
Mailing Address - Fax:413-538-6026
Practice Address - Street 1:129 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1388
Practice Address - Country:US
Practice Address - Phone:413-538-5620
Practice Address - Fax:413-538-6026
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59580207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
720299OtherCONNECTICARE
31545OtherHARVARD PILGRIM
100612OtherCIGNA
MA3032922Medicaid
000000022243OtherBMC HEALTHNET PLAN
12373OtherHEALTH NEW ENGLAND
76510OtherTUFTS
J07292Medicare PIN
720299OtherCONNECTICARE