Healthcare Provider Details

I. General information

NPI: 1477649176
Provider Name (Legal Business Name): GEORGE EDWARD FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5751 NORTH BROAD STREET
PHILADELPHIA PA
19141
US

IV. Provider business mailing address

5751 NORTH BROAD STREET
PHILADELPHIA PA
19141
US

V. Phone/Fax

Practice location:
  • Phone: 215-843-0672
  • Fax: 215-843-0674
Mailing address:
  • Phone: 215-843-0672
  • Fax: 215-843-0674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD061558L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: