Provider Demographics
NPI:1558359885
Name:FICHMAN, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:FICHMAN
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 1:678 PETALUMA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4217
Mailing Address - Country:US
Mailing Address - Phone:707-829-1811
Mailing Address - Fax:707-829-5593
Practice Address - Street 1:678 PETALUMA AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4217
Practice Address - Country:US
Practice Address - Phone:707-829-1811
Practice Address - Fax:707-829-5593
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56079207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G560790Medicaid
A53081Medicare UPIN
CA00G560790Medicare PIN