Provider Demographics
NPI:1649487471
Name:MARK A. FISHER, MD, PA
Entity type:Organization
Organization Name:MARK A. FISHER, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-655-9050
Mailing Address - Street 1:127 PINE ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-4855
Mailing Address - Country:US
Mailing Address - Phone:973-655-9050
Mailing Address - Fax:
Practice Address - Street 1:127 PINE ST
Practice Address - Street 2:SUITE 5
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-4855
Practice Address - Country:US
Practice Address - Phone:973-655-9050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA68626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA68626OtherSTATE LICENSE
NJ8536805Medicaid
NJMA68626OtherSTATE LICENSE
NJ8536805Medicaid