Healthcare Provider Details

I. General information

NPI: 1114372984
Provider Name (Legal Business Name): BENJAMIN WILSON FISHER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2016
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEISINGER MEDICAL CTR 100 NORTH ACADEMY AVENUE
DANVILLE PA
17822-0001
US

IV. Provider business mailing address

PO BOX 802843
KANSAS CITY MO
64180-2843
US

V. Phone/Fax

Practice location:
  • Phone: 570-271-6211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number2022031318
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: