Provider Demographics
NPI:1801013735
Name:FISHMAN, MARC L (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:L
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 1:670 NW 101ST TER
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1060
Mailing Address - Country:US
Mailing Address - Phone:954-562-4884
Mailing Address - Fax:954-370-5067
Practice Address - Street 1:670 NW 101ST TER
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1060
Practice Address - Country:US
Practice Address - Phone:954-562-4884
Practice Address - Fax:954-370-5067
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME40052207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE98173Medicare UPIN
FL94028YMedicare ID - Type Unspecified