Provider Demographics
NPI:1609821404
Name:FISCHER, STACI ANN (MD)
Entity Type:Individual
Prefix:
First Name:STACI
Middle Name:ANN
Last Name:FISCHER
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 1:593 EDDY STREET
Mailing Address - Street 2:APC921
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903
Mailing Address - Country:US
Mailing Address - Phone:401-444-8450
Mailing Address - Fax:401-444-5088
Practice Address - Street 1:593 EDDY STREET
Practice Address - Street 2:APC921
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:401-444-8450
Practice Address - Fax:401-444-5088
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10461207RI0200X
RI05-0450410207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5289098Medicaid
RI9022995Medicaid
F56804Medicare UPIN
MA5289098Medicaid