Provider Demographics
NPI:1013900331
Name:FISKE, CHARLES E (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:E
Last Name:FISKE
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 1:411 30TH ST
Mailing Address - Street 2:#508
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3310
Mailing Address - Country:US
Mailing Address - Phone:925-274-4950
Mailing Address - Fax:925-274-4975
Practice Address - Street 1:411 30TH ST
Practice Address - Street 2:#508
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3310
Practice Address - Country:US
Practice Address - Phone:925-274-4950
Practice Address - Fax:925-274-4975
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG350572085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A46201Medicare UPIN
CA00G350572Medicare PIN
00G350570Medicare PIN
CA00G350573Medicare PIN
CAAR417ZMedicare PIN