Provider Demographics
NPI:1629075700
Name:FISK, JOHN M (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:M
Last Name:FISK
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Gender:M
Credentials:MD
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Mailing Address - Street 1:ONE ATWELL ROAD
Mailing Address - Street 2:BASSETT MEDICAL CENTER,
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326
Mailing Address - Country:US
Mailing Address - Phone:607-547-6933
Mailing Address - Fax:607-547-3203
Practice Address - Street 1:ONE ATWELL ROAD
Practice Address - Street 2:BASSETT MEDICAL CENTER,
Practice Address - City:COOPERSTOWN
Practice Address - State:NY
Practice Address - Zip Code:13326
Practice Address - Country:US
Practice Address - Phone:607-547-6933
Practice Address - Fax:607-547-3203
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-06-15
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Provider Licenses
StateLicense IDTaxonomies
NY235482207ZB0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYRB3053Medicare PIN