Healthcare Provider Details

I. General information

NPI: 1053664136
Provider Name (Legal Business Name): BEVERLY A FISCHER MD P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2012
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12205 TULLAMORE RD
TIMONIUM MD
21093-7816
US

IV. Provider business mailing address

12205 TULLAMORE RD
TIMONIUM MD
21093-7816
US

V. Phone/Fax

Practice location:
  • Phone: 410-308-4700
  • Fax: 410-308-4704
Mailing address:
  • Phone: 410-308-4700
  • Fax: 410-308-4704

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BEVERLY A. FISCHER
Title or Position: OWNER
Credential: M.D.
Phone: 410-308-4700