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NPI Code Detail

MEDICARE: EILEEN R FISK M.D.

MEDICARE: EILEEN R FISK M.D.
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
1208000000XPediatrics Physician208473MA

General Provider Information

NPI Number : 1588601199
Entity Type Code : Individual
Provider Name (Legal Business Name) : EILEEN R FISK M.D.
Provider Business Mailing Address
First Line : 269 UNION ST
Second Line : LYNN COMMUNITY HEALTH CENTER
City : LYNN
State : MA
Zip : 01901-1314
Country : US
Telephone Number : 781-581-3900
Fax Number :
Provider Business Practice Location Address
First Line : 269 UNION ST
Second Line :
City : LYNN
State : MA
Zip : 01901-1314
Country : US
Telephone Number : 781-581-3900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2006
Last Update Date : 07/08/2007

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Directions to “ EILEEN R FISK M.D.” Practice Location

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