Provider Demographics
NPI:1598752438
Name:FISCHBECK, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:FISCHBECK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1244
Mailing Address - Country:US
Mailing Address - Phone:716-592-2832
Mailing Address - Fax:716-592-4452
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1244
Practice Address - Country:US
Practice Address - Phone:716-592-2832
Practice Address - Fax:716-592-4452
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162726208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00010055503OtherUNIVERA
NY1208949OtherIHA
NY040426001493OtherFIDELIS
NY000504780004OtherBC/BS
NY01083912Medicaid
NY14692DLOtherPREFERRED CARE
NY1208949OtherIHA
NY01083912Medicaid