Provider Demographics
NPI:1598849788
Name:CRAIG FISCHER, MD MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CRAIG FISCHER, MD MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-843-2220
Mailing Address - Street 1:2006 DWIGHT WAY STE 304
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2633
Mailing Address - Country:US
Mailing Address - Phone:510-843-2220
Mailing Address - Fax:510-843-2227
Practice Address - Street 1:2006 DWIGHT WAY STE 304
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2633
Practice Address - Country:US
Practice Address - Phone:510-843-2220
Practice Address - Fax:510-843-2227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0257332084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG025733OtherSTATE LICENSE
CA00G257330Medicare ID - Type Unspecified
CAG025733OtherSTATE LICENSE