Provider Demographics
NPI:1205875820
Name:FISHMAN, MARTIN L (MD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:L
Last Name:FISHMAN
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 1:10300 S DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3030
Mailing Address - Country:US
Mailing Address - Phone:408-252-7100
Mailing Address - Fax:408-257-8355
Practice Address - Street 1:431 MONTEREY AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5319
Practice Address - Country:US
Practice Address - Phone:408-354-9510
Practice Address - Fax:408-395-1610
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG26839207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G268390Medicaid
CA00G268390Medicare ID - Type Unspecified
CA00G268390Medicaid