Healthcare Provider Details

I. General information

NPI: 1083171029
Provider Name (Legal Business Name): PATRICK FISHER PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

462 GRIDER ST
BUFFALO NY
14215-3021
US

IV. Provider business mailing address

15 STRATFORD RD UPPR
BUFFALO NY
14216-1803
US

V. Phone/Fax

Practice location:
  • Phone: 716-898-3000
  • Fax:
Mailing address:
  • Phone: 716-697-4301
  • Fax:

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 Code363A00000X
TaxonomyPhysician Assistant
License Number023425
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: