Provider Demographics
NPI:1952456659
Name:FISHER, KENNETH KEITH (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:KEITH
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:PO 639
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20725
Mailing Address - Country:US
Mailing Address - Phone:301-317-0020
Mailing Address - Fax:301-317-0028
Practice Address - Street 1:1711 LIVINGSTON ROAD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744
Practice Address - Country:US
Practice Address - Phone:301-317-0020
Practice Address - Fax:301-317-0028
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061213207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology