Provider Demographics
NPI:1730165002
Name:FLEISCHER, ALAN BERNARD JR (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:BERNARD
Last Name:FLEISCHER
Suffix:JR
Gender:M
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:PO BOX 636256
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6256
Mailing Address - Country:US
Mailing Address - Phone:513-585-5505
Mailing Address - Fax:513-585-5511
Practice Address - Street 1:3130 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219
Practice Address - Country:US
Practice Address - Phone:513-584-3686
Practice Address - Fax:513-475-7636
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY48432207N00000X
OH35.133947207N00000X
NC33040207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
32528OtherBCBS
SCQ33040Medicaid
2962OtherPARTNERS
WV195754000Medicaid
KY48432OtherKENTUCKY BOARD OF MEDICAL LICENSURE
VA5940184Medicaid
63998OtherMEDCOST
NC8932528Medicaid
4618265OtherAETNA
63998OtherMEDCOST
4618265OtherAETNA