Provider Demographics
NPI:1639265648
Name:FISHER, RONALD JAMES (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2542 LANGHORNE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1602
Mailing Address - Country:US
Mailing Address - Phone:434-947-5297
Mailing Address - Fax:434-947-5371
Practice Address - Street 1:2542 LANGHORNE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1602
Practice Address - Country:US
Practice Address - Phone:434-200-5297
Practice Address - Fax:434-200-5371
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101055935208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340000702OtherPSC MEDICARE PROVIDER #
VA7500432Medicaid
VA7500432Medicaid
VA340000702OtherPSC MEDICARE PROVIDER #