Provider Demographics
NPI:1184617409
Name:FISHER, BARRY A (MD)
Entity type:Individual
Prefix:
First Name:BARRY
Middle Name:A
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 BOX 711808
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-1808
Mailing Address - Country:US
Mailing Address - Phone:937-384-4838
Mailing Address - Fax:937-384-4845
Practice Address - Street 1:6438 WILMINGTON PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-7010
Practice Address - Country:US
Practice Address - Phone:937-885-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35053972207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0632659Medicaid
OH080152611OtherMEDICARE RR
OH0587088Medicare PIN
OH0587089Medicare PIN
OH0632659Medicaid