Healthcare Provider Details

I. General information

NPI: 1750376893
Provider Name (Legal Business Name): MATTHEW FISHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 06/18/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 REGIONAL DR
PINEHURST NC
28374-8850
US

IV. Provider business mailing address

2 HOT METAL ST QUANTUM ONE, SUITE 001
PITTSBURGH PA
15203-2348
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-5511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number00416
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberMD422593
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: