Provider Demographics
NPI:1497872709
Name:FISHMAN, ARKADY S (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:
First Name:ARKADY
Middle Name:S
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 ALLSTON STREET
Mailing Address - Street 2:#307
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-731-6110
Mailing Address - Fax:
Practice Address - Street 1:1180 BEACON STREET
Practice Address - Street 2:ROOM 6A
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-731-6110
Practice Address - Fax:617-731-8466
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50408207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3003833Medicaid
MAJ05169Medicare ID - Type Unspecified
MA3003833Medicaid