Provider Demographics
NPI:1710037569
Name:FISKE, DANA ROSS (AUD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:ROSS
Last Name:FISKE
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BORTHWICK AVE
Mailing Address - Street 2:SUITE 209
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4174
Mailing Address - Country:US
Mailing Address - Phone:603-436-8668
Mailing Address - Fax:603-436-4499
Practice Address - Street 1:330 BORTHWICK AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4174
Practice Address - Country:US
Practice Address - Phone:603-436-8668
Practice Address - Fax:603-436-4499
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH231H00000X231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7308803Y0NH01OtherANTHEM BCBS
NH80648803Medicaid
23087YMedicare UPIN
NHNH8803Medicare ID - Type Unspecified