Healthcare Provider Details

I. General information

NPI: 1558529388
Provider Name (Legal Business Name): MITCHELL ALLAN FLEISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROCK FISH CENTER SUITE 1 SR 664
NELLYSFORD VA
22958
US

IV. Provider business mailing address

PO BOX 303 ROCKFISH CENTER SUITE 1 SR 664
NELLYSFORD VA
22958
US

V. Phone/Fax

Practice location:
  • Phone: 434-361-1896
  • Fax: 434-361-1928
Mailing address:
  • Phone: 434-361-1896
  • Fax: 434-361-1928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101037274
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: