Provider Demographics
NPI:1598766552
Name:FISCHER, BRUCE EVAN (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:EVAN
Last Name:FISCHER
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 1:1180 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:RI
Mailing Address - Zip Code:02809-1126
Mailing Address - Country:US
Mailing Address - Phone:401-253-8900
Mailing Address - Fax:401-253-3131
Practice Address - Street 1:1180 HOPE ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:RI
Practice Address - Zip Code:02809-1126
Practice Address - Country:US
Practice Address - Phone:401-253-8900
Practice Address - Fax:401-253-3131
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD8183207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI12-00496OtherUNITED HEALTH CARE
RI206515OtherHAVARD PILGRIM HEALTH
RI004469OtherBCHIP
RI9002400Medicaid
RI0000002400OtherB/C
RI3751OtherNEIGHBORHOOD HEALTH
RI406142OtherTUFTS HEALTH PLAN
RI9002400Medicaid