Provider Demographics
NPI:1760456164
Name:FISHER, RICHARD ERNEST (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ERNEST
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 1:5505 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:MD
Mailing Address - Zip Code:21225-3444
Mailing Address - Country:US
Mailing Address - Phone:410-355-0340
Mailing Address - Fax:410-636-3403
Practice Address - Street 1:5505 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:MD
Practice Address - Zip Code:21225-3444
Practice Address - Country:US
Practice Address - Phone:410-355-0340
Practice Address - Fax:410-636-3403
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0002519207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD306311900Medicaid
MD306311900Medicaid
MD306311900Medicaid
MD110045647Medicare PIN