Healthcare Provider Details

I. General information

NPI: 1730190034
Provider Name (Legal Business Name): ERIC FISHER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 WILLIAM F PALMER RD
MOODUS CT
06469-1132
US

IV. Provider business mailing address

28 CRESCENT ST
MIDDLETOWN CT
06457-3654
US

V. Phone/Fax

Practice location:
  • Phone: 860-358-5220
  • Fax: 860-358-8659
Mailing address:
  • Phone: 860-358-4811
  • Fax: 860-358-8661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number042142
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: