Healthcare Provider Details

I. General information

NPI: 1740801950
Provider Name (Legal Business Name): VICTORIA GROBAN FISCHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 W COLE RD
BIDDEFORD ME
04005-9453
US

IV. Provider business mailing address

30 W COLE RD
BIDDEFORD ME
04005-9453
US

V. Phone/Fax

Practice location:
  • Phone: 207-284-6673
  • Fax: 207-294-7365
Mailing address:
  • Phone: 207-284-6673
  • Fax: 207-294-7365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD30971
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberDR.0075809
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberMD30971
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: