Healthcare Provider Details

I. General information

NPI: 1437154770
Provider Name (Legal Business Name): BARRY JASON FISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3428 W MARKET ST STE 100
FAIRLAWN OH
44333-3339
US

IV. Provider business mailing address

3428 W MARKET ST STE 100
FAIRLAWN OH
44333-3339
US

V. Phone/Fax

Practice location:
  • Phone: 330-665-8064
  • Fax: 330-665-8069
Mailing address:
  • Phone: 330-665-8064
  • Fax: 330-665-8069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number35071927
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: