MEDICARE: DR. RONALD FISHER 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
1	2084P0800X	Psychiatry Physician	MD057750L	PA

General Provider Information

NPI Number	:	1760488878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD FISHER M.D.

Provider Business Mailing Address
First Line	:	311 SOUTH ALLEN ST.
Second Line	:	SUITE C-3
City	:	STATE COLLEGE
State	:	PA
Zip	:	16801-1680
Country	:	US
Telephone Number	:	814-231-3888
Fax Number	:	814-231-3888

Provider Business Practice Location Address
First Line	:	900 BRYAN ST
Second Line	:	SUITE 5
City	:	HUNTINGDON
State	:	PA
Zip	:	16652-2413
Country	:	US
Telephone Number	:	814-643-8442
Fax Number	:	814-643-8776

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

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	07/08/2007

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