Healthcare Provider Details

I. General information

NPI: 1447229562
Provider Name (Legal Business Name): MARK DONALD FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 11/21/2023
Certification Date: 11/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1207 DELAWARE AVE STE 490
BUFFALO NY
14209-1458
US

IV. Provider business mailing address

3090 CLOVERBANK RD
HAMBURG NY
14075-3424
US

V. Phone/Fax

Practice location:
  • Phone: 716-830-1350
  • Fax: 716-205-7525
Mailing address:
  • Phone: 716-830-1350
  • Fax: 716-205-7525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number207389
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: