Provider Demographics
NPI:1881896728
Name:DENNIS J FISHER, M.D., P.A.
Entity type:Organization
Organization Name:DENNIS J FISHER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-763-9664
Mailing Address - Street 1:21 GAMECOCK AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-3368
Mailing Address - Country:US
Mailing Address - Phone:843-763-9664
Mailing Address - Fax:843-763-2949
Practice Address - Street 1:21 GAMECOCK AVE
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-3368
Practice Address - Country:US
Practice Address - Phone:843-763-9664
Practice Address - Fax:843-763-2949
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-04
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1901Medicare ID - Type Unspecified
SCC60591Medicare UPIN