MEDICARE: DR. JAMES R FISCO D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	34004435F	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	080191710	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2202445	OTHER	OH	AETNA
2	000000337888	OTHER	OH	UNICARE
3	0443503	OTHER	OH	HUMANA/CHOICECARE
4	421534506086	OTHER	OH	CARESOURCE
6	000000227888	OTHER	OH	ANTHEM
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	0102237	OTHER	OH	UNITED HEALTH CARE
9	34004435F	OTHER	OH	MEDICAL LICENSE

General Provider Information

NPI Number	:	1245233766
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES R FISCO D.O.

Provider Business Mailing Address
First Line	:	2912 SPRINGBORO W
Second Line	:	STE 201
City	:	DAYTON
State	:	OH
Zip	:	45439-1674
Country	:	US
Telephone Number	:	937-297-8996
Fax Number	:	937-885-0702

Provider Business Practice Location Address
First Line	:	70 REMICK BLVD
Second Line	:
City	:	SPRINGBORO
State	:	OH
Zip	:	45066-9168
Country	:	US
Telephone Number	:	937-885-0701
Fax Number	:	937-885-0702

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/30/2005
Last Update Date	:	05/08/2014

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Directions to “ DR. JAMES R FISCO D.O.” Practice Location

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