Provider Demographics
NPI:1992223283
Name:FISHER, AVERY (CNM)
Entity Type:Individual
Prefix:
First Name:AVERY
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 OLD ROAD TO 9 ACRE COR STE 830
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4191
Mailing Address - Country:US
Mailing Address - Phone:798-371-1396
Mailing Address - Fax:978-371-8277
Practice Address - Street 1:131 OLD ROAD TO 9 ACRE COR STE 830
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4191
Practice Address - Country:US
Practice Address - Phone:978-371-8277
Practice Address - Fax:978-371-8277
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MARN2313599207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology