Provider Demographics
NPI:1821069956
Name:FISHER, NEIL WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:NEIL
Middle Name:WILLIAM
Last Name:FISHER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:48 TUNNEL RD
Practice Address - Street 2:SUITE 205
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3875
Practice Address - Country:US
Practice Address - Phone:570-622-1400
Practice Address - Fax:570-622-8900
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005432L208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001264086Medicaid
PA001264086Medicaid
PA120174DX6Medicare ID - Type Unspecified