=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063510675
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH FISHER M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 05/16/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 519 US ROUTE 1 UNIT 2
-----------------------------------------------------
City | YORK
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 03909-1640
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-351-1266
-----------------------------------------------------
Fax | 207-363-4905
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 401 ANDOVER ST SUITE 101
-----------------------------------------------------
City | NORTH ANDOVER
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01845-5076
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-691-5690
-----------------------------------------------------
Fax | 978-691-5693
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 10992
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | 015408
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------