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General NPI Number Information
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NPI Number | 1659457950
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Entity Type | Individual
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Provider Name | MARK LOUIS FISHER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 10/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 537 RITCHIE HWY STE 1C
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City | SEVERNA PARK
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State | MD
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Zip | 21146-2930
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Country | US
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Telephone | 410-315-7715
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Fax | 410-315-7541
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Provider Business Mailing Address
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Address Line | 764 DIVIDING RD
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City | SEVERNA PARK
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State | MD
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Zip | 21146-4324
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Country | US
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Telephone | 410-544-7352
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2572
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License Number State | MD
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