Provider Demographics
NPI:1063515849
Name:FISCHER, IAN GERARD (MPT)
Entity type:Individual
Prefix:MR
First Name:IAN
Middle Name:GERARD
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10085 RED RUN BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4836
Mailing Address - Country:US
Mailing Address - Phone:410-363-7123
Mailing Address - Fax:410-363-0054
Practice Address - Street 1:10085 RED RUN BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4836
Practice Address - Country:US
Practice Address - Phone:410-363-7123
Practice Address - Fax:410-363-0054
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD132685225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD216516Medicare UPIN
MD216516Medicare PIN