Healthcare Provider Details

I. General information

NPI: 1770744963
Provider Name (Legal Business Name): KIMBERLY LYNN FISCHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 01/15/2025
Certification Date: 01/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4844 GEORGE WASHINGTON MEMORIAL HIGHWAY SUITE 8
WHITE MARSH VA
23183
US

IV. Provider business mailing address

4844 GEORGE WASHINGTON MEMORIAL HIGHWAY SUITE 8
WHITE MARSH VA
23183
US

V. Phone/Fax

Practice location:
  • Phone: 804-693-4410
  • Fax: 804-693-0925
Mailing address:
  • Phone: 804-693-4410
  • Fax: 804-693-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number036144769
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number0101245695
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number152716
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: