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General NPI Number Information
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NPI Number | 1952456659
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Entity Type | Individual
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Provider Name | KENNETH KEITH FISHER MD
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1711 LIVINGSTON ROAD
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City | FORT WASHINGTON
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State | MD
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Zip | 20744
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Country | US
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Telephone | 301-317-0020
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Fax | 301-317-0028
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Provider Business Mailing Address
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Address Line | PO 639
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City | LAUREL
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State | MD
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Zip | 20725
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Country | US
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Telephone | 301-317-0020
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Fax | 301-317-0028
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | D0061213
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License Number State | MD
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