Healthcare Provider Details

I. General information

NPI: 1730545120
Provider Name (Legal Business Name): DANE ANDREW FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2016
Last Update Date: 03/04/2025
Certification Date: 03/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 MDG NEALY AVENUE
JB LANGLEY-EUSTIS VA
23665-2040
US

IV. Provider business mailing address

633 MDG NEALY AVENUE
JB LANGLEY-EUSTIS VA
23665-2040
US

V. Phone/Fax

Practice location:
  • Phone: 757-225-7630
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA180422
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101262898
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: