Healthcare Provider Details

I. General information

NPI: 1295798569
Provider Name (Legal Business Name): ROBERT T. FISHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 06/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52 THOMAS JOHNSON DR
FREDERICK MD
21702-4300
US

IV. Provider business mailing address

52 THOMAS JOHNSON DR
FREDERICK MD
21702-4300
US

V. Phone/Fax

Practice location:
  • Phone: 301-663-9573
  • Fax: 301-663-6446
Mailing address:
  • Phone: 301-663-9573
  • Fax: 301-663-6446

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberD23002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: