MEDICARE: GARY J FISHBEIN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	35-06-5086	OH
2	207RI0011X	Interventional Cardiology Physician	35-06-5086	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184626384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY J FISHBEIN MD

Provider Business Mailing Address
First Line	:	3170 KETTERING BLVD STE 300
Second Line	:
City	:	MORAINE
State	:	OH
Zip	:	45439-1924
Country	:	US
Telephone Number	:	937-991-3188
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	2350 MIAMI VALLEY DR STE 310
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4778
Country	:	US
Telephone Number	:	937-277-4274
Fax Number	:	937-277-8476

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	03/22/2022

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Directions to “ GARY J FISHBEIN MD” Practice Location

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