Provider Demographics
NPI:1013935659
Name:FISCH, ARDIS BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ARDIS
Middle Name:BETH
Last Name:FISCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:760 FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:LEE
Mailing Address - State:MA
Mailing Address - Zip Code:01238-9334
Mailing Address - Country:US
Mailing Address - Phone:413-243-3104
Mailing Address - Fax:413-243-1458
Practice Address - Street 1:192 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEE
Practice Address - State:MA
Practice Address - Zip Code:01238-1616
Practice Address - Country:US
Practice Address - Phone:413-822-2096
Practice Address - Fax:413-243-1458
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211621207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G79207Medicare UPIN