Provider Demographics
NPI:1598266306
Name:FISCHER, DEREK THOMAS (MS RD CD)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:THOMAS
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MS RD CD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1807 N LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-1272
Mailing Address - Country:US
Mailing Address - Phone:567-204-7699
Mailing Address - Fax:
Practice Address - Street 1:1807 N LINCOLN ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-1272
Practice Address - Country:US
Practice Address - Phone:567-204-7699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86082185133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered