Provider Demographics
NPI:1013058916
Name:FISCHER NEUROLOGY ASSOC PC
Entity Type:Organization
Organization Name:FISCHER NEUROLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MAUD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTY-FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-979-9009
Mailing Address - Street 1:830 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-2711
Mailing Address - Country:US
Mailing Address - Phone:781-979-9009
Mailing Address - Fax:781-979-9008
Practice Address - Street 1:830 MAIN ST. GROUND LEVEL
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:MA
Practice Address - Zip Code:02176-2711
Practice Address - Country:US
Practice Address - Phone:781-979-9009
Practice Address - Fax:781-979-9008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9763431Medicaid
MA9763431Medicaid