Provider Demographics
NPI:1295724847
Name:DAVID J. FISHMAN, M.D., INC.
Entity type:Organization
Organization Name:DAVID J. FISHMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-289-8149
Mailing Address - Street 1:26250 EUCLID AVE
Mailing Address - Street 2:SUITE 711
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44132-3305
Mailing Address - Country:US
Mailing Address - Phone:216-289-8149
Mailing Address - Fax:216-289-3305
Practice Address - Street 1:26250 EUCLID AVE
Practice Address - Street 2:SUITE 711
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44132-3305
Practice Address - Country:US
Practice Address - Phone:216-289-8149
Practice Address - Fax:216-289-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH039578174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0215903Medicaid
OH000000136594OtherANTHEM
OHA80173Medicare UPIN
OH0215903Medicaid