Provider Demographics
NPI:1508872995
Name:FISHER, JONATHAN ELIOT ESTE (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ELIOT ESTE
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-887-4530
Mailing Address - Fax:704-887-4531
Practice Address - Street 1:10030 GILEAD RD STE 201
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-7545
Practice Address - Country:US
Practice Address - Phone:704-887-4530
Practice Address - Fax:704-887-4531
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2213371207RC0000X
NC2008-00026207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
609Q6OtherBLUE CROSS
2103597OtherGHI
P3682274OtherOXFORD
2381008OtherUNITED
3002OtherNEIC SITE ID
4598351OtherCIGNA
7622585OtherAETNA
3C6005OtherHEALTHNET
JF0609Q610OtherBLUE CROSS BLUE SHIELD
P3682274OtherOXFORD
609Q6OtherBLUE CROSS
JF0552P910Medicare ID - Type UnspecifiedID NUMBER