Provider Demographics
NPI:1265427751
Name:FISHER, LAWRENCE (MD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
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 1:1305 POST RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-6016
Mailing Address - Country:US
Mailing Address - Phone:203-292-2000
Mailing Address - Fax:203-255-5212
Practice Address - Street 1:25 GERMANTOWN RD
Practice Address - Street 2:SUITE 2B
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5013
Practice Address - Country:US
Practice Address - Phone:203-794-0090
Practice Address - Fax:203-830-4614
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT30690174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTE66261Medicare UPIN