Provider Demographics
NPI:1700292950
Name:FISCHER, RUTH (PA)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:RUTH
Other - Middle Name:
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1860 TOWN CENTER DR STE 110
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5898
Mailing Address - Country:US
Mailing Address - Phone:703-796-0200
Mailing Address - Fax:
Practice Address - Street 1:1860 TOWN CENTER DR STE 110
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5898
Practice Address - Country:US
Practice Address - Phone:703-796-0200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110008012363A00000X
NY017381363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant