Provider Demographics
NPI:1639297781
Name:FISHKIN, DAVID L (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:FISHKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2010 DR OATES DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401
Mailing Address - Country:US
Mailing Address - Phone:304-263-8200
Mailing Address - Fax:304-263-9242
Practice Address - Street 1:2010 DOCTOR OATES DR
Practice Address - Street 2:S-103
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-8896
Practice Address - Country:US
Practice Address - Phone:304-263-8200
Practice Address - Fax:304-263-9242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV17136174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV6050031Medicaid
FI0731641Medicare ID - Type Unspecified
WV6050031Medicaid