Healthcare Provider Details

I. General information

NPI: 1912744210
Provider Name (Legal Business Name): MICHAEL FISHMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2024
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
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
17042-7497
US

V. Phone/Fax

Practice location:
  • Phone: 717-273-6706
  • Fax: 717-273-6706
Mailing address:
  • Phone: 717-273-6706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DENNIS P CREEDON
Title or Position: MANAGER
Credential: BSN
Phone: 717-273-6706