Healthcare Provider Details

I. General information

NPI: 1578547261
Provider Name (Legal Business Name): ANDREA B FISCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 SINCLAIR LANE SCHOOL BASED HEALTH- THAT PLACE
BALTIMORE MD
21213
US

IV. Provider business mailing address

3501 SINCLAIR LANE
BALTIMORE MD
21213
US

V. Phone/Fax

Practice location:
  • Phone: 410-325-2397
  • Fax: 410-485-4359
Mailing address:
  • Phone: 410-558-4888
  • Fax: 410-327-1693

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR107082
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: