Provider Demographics
NPI:1629036769
Name:FISHER, STEVEN J (DO)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4000 EDGMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:19015-2211
Mailing Address - Country:US
Mailing Address - Phone:610-876-3500
Mailing Address - Fax:610-876-8660
Practice Address - Street 1:4000 EDGMONT AVE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:PA
Practice Address - Zip Code:19015-2211
Practice Address - Country:US
Practice Address - Phone:610-876-3500
Practice Address - Fax:610-876-8660
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS003211L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC32875Medicare UPIN
PA177750Medicare ID - Type Unspecified