Provider Demographics
NPI:1891862090
Name:FISH, GABRIELLE A (DO)
Entity Type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:A
Last Name:FISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-1625
Mailing Address - Country:US
Mailing Address - Phone:856-427-4001
Mailing Address - Fax:856-427-4003
Practice Address - Street 1:432 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-1625
Practice Address - Country:US
Practice Address - Phone:856-427-4001
Practice Address - Fax:856-427-4003
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS008700L207QA0505X
NJ25MB06304700207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA577589UELMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #
NJ093403UHEMedicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #
NJF65215Medicare UPIN