Provider Demographics
NPI:1912125204
Name:FISHER, KRISTOPHER REED (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTOPHER
Middle Name:REED
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:428 COUNTRY LINE RD W
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7294
Mailing Address - Country:US
Mailing Address - Phone:614-847-4100
Mailing Address - Fax:614-430-1601
Practice Address - Street 1:235 W. SCHROCK RD
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-2874
Practice Address - Country:US
Practice Address - Phone:614-895-0400
Practice Address - Fax:614-895-2911
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN44888207N00000X, 207ZP0102X, 207ND0900X
SC32355207N00000X
OH35137423207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003181475AMedicaid
AL184357Medicaid
MS07820719Medicaid
MO1912125204Medicaid
AR186863001Medicaid
OH0388256Medicaid
TN1523453Medicaid