Healthcare Provider Details

I. General information

NPI: 1639313976
Provider Name (Legal Business Name): MIRIAM RUTH FISCHER WACHTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2009
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

21 BARTLETT CRES
BROOKLINE MA
02446-2208
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-2424
  • Fax:
Mailing address:
  • Phone: 607-227-9778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101251966
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberMD046798
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: