Provider Demographics
NPI:1538199096
Name:FISCHER, BEVERLY ANNE (MD)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:ANNE
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 1:12205 TULLAMORE RD # 12205
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-7816
Mailing Address - Country:US
Mailing Address - Phone:410-308-4700
Mailing Address - Fax:410-308-4704
Practice Address - Street 1:12205 TULLAMORE RD
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-7816
Practice Address - Country:US
Practice Address - Phone:410-308-4700
Practice Address - Fax:410-308-4704
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00372632086S0122X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKG04AD 53289903OtherCAREFIRST
GADE665 240006092OtherRAILROAD MEDICARE
MD298161100Medicaid
DCE422 0001OtherCAREFIRST
MD181P 181P420GMedicare PIN
MDKG04AD 53289903OtherCAREFIRST