Healthcare Provider Details

I. General information

NPI: 1073050175
Provider Name (Legal Business Name): THOMAS A FISHER BC ACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: THOMAS A FISHER BC ACA

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 BEL AIR RD
FALLSTON MD
21047-2871
US

IV. Provider business mailing address

2701 BEL AIR RD
FALLSTON MD
21047-2871
US

V. Phone/Fax

Practice location:
  • Phone: 410-838-2800
  • Fax: 410-877-7087
Mailing address:
  • Phone: 410-838-2800
  • Fax: 410-877-7087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number01289
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number03-0000030
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: