Provider Demographics
NPI:1134167430
Name:FISCHER, HEIDI (MD)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 CLARKE RD
Mailing Address - Street 2:
Mailing Address - City:NEEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02492-1308
Mailing Address - Country:US
Mailing Address - Phone:617-571-6796
Mailing Address - Fax:
Practice Address - Street 1:ONE WASHINGTON STREET
Practice Address - Street 2:SUITE 403
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-1711
Practice Address - Country:US
Practice Address - Phone:781-235-5100
Practice Address - Fax:781-235-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-02
Last Update Date:2016-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA158850207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3205070Medicaid
MAA3070201Medicare PIN
MAG48524Medicare UPIN