Provider Demographics
NPI:1710159207
Name:FISHER, CHESTER LIONEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHESTER
Middle Name:LIONEL
Last Name:FISHER
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:11747 JEFFERSON AVENUE
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606
Mailing Address - Country:US
Mailing Address - Phone:757-591-8100
Mailing Address - Fax:757-591-8600
Practice Address - Street 1:11747 JEFFERSON AVENUE
Practice Address - Street 2:SUITE 1B
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606
Practice Address - Country:US
Practice Address - Phone:757-591-8100
Practice Address - Fax:757-591-8600
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
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Provider Licenses
StateLicense IDTaxonomies
VA0101032335207Q00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B07574Medicare UPIN