Provider Demographics
NPI:1669415782
Name:FISCHER, MARK B (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:B
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4070 BUTLER PIKE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1556
Mailing Address - Country:US
Mailing Address - Phone:610-825-5741
Mailing Address - Fax:610-825-1855
Practice Address - Street 1:4070 BUTLER PIKE
Practice Address - Street 2:SUITE 200
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1556
Practice Address - Country:US
Practice Address - Phone:610-825-5741
Practice Address - Fax:610-825-1855
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD073943L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0185488803OtherAMERICHOICE (UHC MA PLAN)
PA10994765OtherCAQH ID#
PA1148530OtherKEYSTONE MERCY
PA080179957OtherRRM
PA1319549OtherHIGHMARK BLUE SHIELD
PA2012578000OtherIBC - PC/KHPE
PA7003723OtherCIGNA HMO/PPO
PA0018548880001Medicaid
PA2012578000OtherAMERIHEALTH/INTERCOUNTY
PA2124497OtherALLIANCE/OPT CHC (MAMSI)
PA36452-MD073943LOtherHEALTH PARTNERS
PA052795HQUMedicare ID - Type UnspecifiedHGSA
PA36452-MD073943LOtherHEALTH PARTNERS