=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295724847
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J. FISHMAN, M.D., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/17/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26250 EUCLID AVE SUITE 711
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44132-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-289-8149
-----------------------------------------------------
Fax | 216-289-3305
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26250 EUCLID AVE SUITE 711
-----------------------------------------------------
City | EUCLID
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44132-3305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 216-289-8149
-----------------------------------------------------
Fax | 216-289-3305
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID J. FISHMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 216-289-8149
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 039578
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------