Provider Demographics
NPI:1760879431
Name:FISH, MADISON (MD)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:STE 240
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-277-9378
Mailing Address - Fax:858-277-9370
Practice Address - Street 1:7695 CARDINAL CT STE 240
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-277-9378
Practice Address - Fax:858-277-9370
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA162818207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology