Provider Demographics
NPI:1245283621
Name:FISHER, GLENN A (MD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:FISHER
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5137
Mailing Address - Fax:740-446-5749
Practice Address - Street 1:100 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:855-446-5937
Practice Address - Fax:740-446-5749
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV16942207Q00000X
OH35.073911207Q00000X
OH35073911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000007237OtherANTHEM BCBS
WV0055114000Medicaid
080107118OtherRR MEDICARE
001714098OtherMOUNTAIN STATE BCBS
OH000000181866OtherUNISON MEDICAID
OH310917085067OtherOH MEDICAID CARESOURCE
OH2025874OtherMOLINA MEDICAID
000000007237OtherANTHEM BCBS
OH000000181866OtherUNISON MEDICAID
F40617Medicare UPIN
080107118OtherRR MEDICARE