Provider Demographics
NPI:1932291523
Name:FISCHER, NATHAN ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ROBERTO
Last Name:FISCHER
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 1:580 COTTAGE GROVE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-3088
Mailing Address - Country:US
Mailing Address - Phone:860-242-6261
Mailing Address - Fax:860-243-5184
Practice Address - Street 1:580 COTTAGE GROVE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-3088
Practice Address - Country:US
Practice Address - Phone:860-242-6261
Practice Address - Fax:860-243-5184
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT015870174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT746105OtherCONNECTICARE
CT1158708Medicaid
CTHAP093OtherOXFORD
CTOPO951OtherASC HEALTHNET
CT010015870CT05OtherANTHEM
CT746105OtherCONNECTICARE
CT040000104Medicare ID - Type Unspecified