Provider Demographics
NPI:1689651747
Name:FISHER, BETH (DO)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30170
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19805-7170
Mailing Address - Country:US
Mailing Address - Phone:302-449-3030
Mailing Address - Fax:302-449-3040
Practice Address - Street 1:124 SLEEPY HOLLOW DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDDLETOWN
Practice Address - State:DE
Practice Address - Zip Code:19709-8894
Practice Address - Country:US
Practice Address - Phone:302-449-3030
Practice Address - Fax:302-449-3040
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC20003601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEE89222Medicare UPIN
DE676652C90Medicare PIN