=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073050175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS A FISHER BC ACA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/26/2017
-----------------------------------------------------
Last Update Date | 01/26/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2701 BEL AIR RD
-----------------------------------------------------
City | FALLSTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21047-2871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-838-2800
-----------------------------------------------------
Fax | 410-877-7087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2701 BEL AIR RD
-----------------------------------------------------
City | FALLSTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21047-2871
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-838-2800
-----------------------------------------------------
Fax | 410-877-7087
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 01289
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 237700000X
-----------------------------------------------------
Taxonomy Name | Hearing Instrument Specialist
-----------------------------------------------------
License Number | 03-0000030
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------