Provider Demographics
NPI:1518090539
Name:BARRY J. FISH, M.D., LLC
Entity Type:Organization
Organization Name:BARRY J. FISH, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-665-8064
Mailing Address - Street 1:3428 W MARKET ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-3339
Mailing Address - Country:US
Mailing Address - Phone:330-665-8064
Mailing Address - Fax:330-665-8069
Practice Address - Street 1:3428 W MARKET ST
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-3339
Practice Address - Country:US
Practice Address - Phone:330-665-8064
Practice Address - Fax:330-665-8069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071927207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHTH9312912OtherMEDICARE 2ND LOCATION
OHTH9312912OtherMEDICARE 2ND LOCATION