Healthcare Provider Details

I. General information

NPI: 1902995343
Provider Name (Legal Business Name): DONNA J FISHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WASON AVE 1ST FL
SPRINGFIELD MA
01107-1274
US

IV. Provider business mailing address

280 CHESTNUT ST 2ND FL
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-794-5437
  • Fax: 413-794-3207
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number78583
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: