Provider Demographics
NPI:1790774339
Name:FISHMAN, DAVID J (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:J
Last Name:FISHMAN
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 1:410 MEDWAY RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3725
Mailing Address - Country:US
Mailing Address - Phone:216-978-4543
Mailing Address - Fax:440-421-9846
Practice Address - Street 1:410 MEDWAY RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND HTS
Practice Address - State:OH
Practice Address - Zip Code:44143-3725
Practice Address - Country:US
Practice Address - Phone:169-784-5432
Practice Address - Fax:404-219-8464
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH039578174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215903Medicaid
OH000000136594OtherANTHEM
OH0215903Medicaid
OH000000136594OtherANTHEM