Provider Demographics
NPI:1700097557
Name:FISS, JOHN D (MD,)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:FISS
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:D
Other - Last Name:FISS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:610-770-1606
Mailing Address - Fax:610-740-0560
Practice Address - Street 1:1200 S CEDAR CREST BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6202
Practice Address - Country:US
Practice Address - Phone:610-402-8080
Practice Address - Fax:610-740-0560
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4315772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1019411260002Medicaid
PAP000427173OtherRAIL ROAD MEDICARE
PA1019411260002Medicaid