Provider Demographics
NPI:1265724900
Name:FISHER, CHARALENE R (MD)
Entity type:Individual
Prefix:DR
First Name:CHARALENE
Middle Name:R
Last Name:FISHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARALENE
Other - Middle Name:R
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1 CHILDRENS WAY # 512-8
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72202-3500
Mailing Address - Country:US
Mailing Address - Phone:501-364-1100
Mailing Address - Fax:501-364-2963
Practice Address - Street 1:1 CHILDRENS WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72202
Practice Address - Country:US
Practice Address - Phone:501-364-1100
Practice Address - Fax:501-364-2963
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE10816208M00000X, 208000000X, 208M00000X, 208000000X
TNMD51562208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist