Provider Demographics
NPI:1902848773
Name:FISCHMAN, MICHAEL ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ALAN
Last Name:FISCHMAN
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 1:8 COLLINS RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-3843
Mailing Address - Country:US
Mailing Address - Phone:860-585-6944
Mailing Address - Fax:860-585-7746
Practice Address - Street 1:8 COLLINS RD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3843
Practice Address - Country:US
Practice Address - Phone:860-585-6944
Practice Address - Fax:860-585-7746
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT029272208800000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT340000209Medicare ID - Type Unspecified
CTF29023Medicare UPIN