Healthcare Provider Details

I. General information

NPI: 1013199488
Provider Name (Legal Business Name): REBECCA M FISHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 12/09/2019
Certification Date: 12/09/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 BLACKSTONE VALLEY PL STE 500
LINCOLN RI
02865-1102
US

IV. Provider business mailing address

6 BLACKSTONE VALLEY PL STE 500
LINCOLN RI
02865-1102
US

V. Phone/Fax

Practice location:
  • Phone: 401-334-1200
  • Fax: 401-334-1111
Mailing address:
  • Phone: 401-334-1200
  • Fax: 401-334-1111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD12762
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: