Provider Demographics
NPI:1659362929
Name:FISHER, GRAEME DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:GRAEME
Middle Name:DONALD
Last Name:FISHER
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 1:6 SANDY RIDGERD
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:MA
Mailing Address - Zip Code:01564
Mailing Address - Country:US
Mailing Address - Phone:978-422-9646
Mailing Address - Fax:
Practice Address - Street 1:4117 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:IL
Practice Address - Zip Code:62864
Practice Address - Country:US
Practice Address - Phone:618-241-7016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1525152085R0001X
IL2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Not Answered2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3162044Medicaid
MA3162044Medicaid
MAG38737Medicare ID - Type Unspecified