Provider Demographics
NPI:1700190287
Name:EDWARD G FISHER MD PC
Entity Type:Organization
Organization Name:EDWARD G FISHER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-581-0200
Mailing Address - Street 1:3536 MINNESOTA AVE SE
Mailing Address - Street 2:#1
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-8270
Mailing Address - Country:US
Mailing Address - Phone:202-581-0200
Mailing Address - Fax:202-581-1040
Practice Address - Street 1:3536 MINNESOTA AVE SE
Practice Address - Street 2:#1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-8270
Practice Address - Country:US
Practice Address - Phone:202-581-0200
Practice Address - Fax:202-581-1040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD25268207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC021769900Medicaid
C88201Medicare UPIN
DC021769900Medicaid