Healthcare Provider Details

I. General information

NPI: 1336183201
Provider Name (Legal Business Name): BRIAN S FISHER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT ST ER DEPARTMENT
CONCORD NH
03301-7539
US

IV. Provider business mailing address

540 LAFAYETTE RD SUITE 8
HAMPTON NH
03842-3344
US

V. Phone/Fax

Practice location:
  • Phone: 603-225-7000
  • Fax: 603-224-6527
Mailing address:
  • Phone: 603-926-0088
  • Fax: 603-926-2853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0375P
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: