Provider Demographics
NPI:1568554921
Name:FISHER, REBECCA A (PA C)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:FISHER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 COMMERCIAL ST
Mailing Address - Street 2:SUITE 401
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5071
Mailing Address - Country:US
Mailing Address - Phone:603-228-7555
Mailing Address - Fax:603-228-7558
Practice Address - Street 1:60 COMMERCIAL ST
Practice Address - Street 2:SUITE 401
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5071
Practice Address - Country:US
Practice Address - Phone:603-228-7555
Practice Address - Fax:603-228-7558
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPA760207Q00000X
NH400363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
P72356Medicare UPIN
RIAP1830Medicare ID - Type Unspecified