Healthcare Provider Details

I. General information

NPI: 1235164617
Provider Name (Legal Business Name): STEVEN J FISHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 LONGWOOD AVE FEGAN 3 CHILDREN'S HOSPITAL BOSTON
BOSTON MA
02115
US

IV. Provider business mailing address

300 LONGWOOD AVE FEGAN 3 CHILDREN'S HOSPITAL BOSTON
BOSTON MA
02115
US

V. Phone/Fax

Practice location:
  • Phone: 617-355-7800
  • Fax:
Mailing address:
  • Phone: 617-355-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number75701
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number75701
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number75701
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number75701
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: