Provider Demographics
NPI:1528017456
Name:FISCHBACH, ADA JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:ADA
Middle Name:JENNIFER
Last Name:FISCHBACH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1121 E 3900 S
Mailing Address - Street 2:STE C240
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1214
Mailing Address - Country:US
Mailing Address - Phone:801-262-9494
Mailing Address - Fax:801-262-0507
Practice Address - Street 1:3838 S 700 E
Practice Address - Street 2:SUITE 100
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106-1466
Practice Address - Country:US
Practice Address - Phone:801-281-6860
Practice Address - Fax:801-281-4822
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2021-09-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT165134-12052085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTE13769Medicare UPIN
UT000059111Medicare PIN
UT005717215Medicare PIN
UT000062423Medicare PIN