Healthcare Provider Details

I. General information

NPI: 1780113787
Provider Name (Legal Business Name): BRIAN FLEISCHER MD, MENG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 ROUTE 70 SUITE C
MARLTON NJ
08053
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-355-7176
  • Fax: 856-762-1249
Mailing address:
  • Phone: 856-355-7176
  • Fax: 856-762-1249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA13138900
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number125070563
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: