Healthcare Provider Details

I. General information

NPI: 1801881875
Provider Name (Legal Business Name): GARY A FISHER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NORWEGIAN PLZ
POTTSVILLE PA
17901-4400
US

IV. Provider business mailing address

1201 GRAMPIAN BLVD STE 3A
WILLIAMSPORT PA
17701-1900
US

V. Phone/Fax

Practice location:
  • Phone: 570-622-8500
  • Fax: 570-622-0261
Mailing address:
  • Phone: 570-322-4025
  • Fax: 570-322-6403

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberOS003192L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: