Healthcare Provider Details

I. General information

NPI: 1043239270
Provider Name (Legal Business Name): ALAN FISCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 MASSACHUSETTS AVE. STE. 2-2, 2-7
CAMBRIDGE MA
02139
US

IV. Provider business mailing address

1000 JEFFERSON ST. STE. 2C
LYNCHBURG VA
24504
US

V. Phone/Fax

Practice location:
  • Phone: 617-395-5806
  • Fax: 617-383-6404
Mailing address:
  • Phone: 617-379-0496
  • Fax: 617-807-0958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number28176
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number28176
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: