Provider Demographics
NPI:1518960939
Name:FISHER, STACY D (MD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:D
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:D
Other - Last Name:GITTLESON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:295 STONER AVE
Practice Address - Street 2:BILLINGSLEA BLDG. SUITE 103
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5698
Practice Address - Country:US
Practice Address - Phone:410-876-0086
Practice Address - Fax:410-871-0030
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0057009207RC0000X
MDD57009207RA0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0002XAllopathic & Osteopathic PhysiciansInternal MedicineAdult Congenital Heart Disease
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD609559-01OtherBLUE CROSS/BLUE SHIELD
MD760005400Medicaid
MDS062-0415OtherBC/BS REGIONAL
MD132921Y3WMedicare PIN
MDG73654Medicare UPIN
MD760005400Medicaid