Healthcare Provider Details

I. General information

NPI: 1841429156
Provider Name (Legal Business Name): MICHAEL ALAN FISHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2009
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 NORMAN DR
LEBANON PA
17042-7497
US

IV. Provider business mailing address

755 NORMAN DR
LEBANON PA
17042-3704
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-6706
  • Fax: 717-273-9910
Mailing address:
  • Phone: 917-543-6588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD450715
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD450715
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberC1-0011247
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberC1-0011247
License Number StateDE
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD450715
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: