Provider Demographics
NPI:1922181635
Name:FISHER, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:FISHER
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 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-2345
Mailing Address - Fax:802-728-2613
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-2345
Practice Address - Fax:802-728-2613
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME011282207P00000X
VT042-0007233207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010453642OtherGREATWEST/ONE HEALTH
VT3009259OtherMVP HEALTH CARE
ME5046643OtherAETNA
ME930011982OtherRR MEDICARE
ME001015OtherANTHEM
ME268340099Medicaid
VT0006637Medicaid
ME010453642OtherMEDNET
ME1922181635OtherTRICARE
MED78610OtherHARVARD PILGRIM
VT0006637Medicaid
MED78610OtherHARVARD PILGRIM
ME010453642OtherGREATWEST/ONE HEALTH