Provider Demographics
NPI:1154385359
Name:FISCHER, JOEL S (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:S
Last Name:FISCHER
Suffix:
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 1:800 W 4TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-5895
Mailing Address - Country:US
Mailing Address - Phone:570-321-0880
Mailing Address - Fax:570-321-8012
Practice Address - Street 1:800 W 4TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-5895
Practice Address - Country:US
Practice Address - Phone:570-321-0880
Practice Address - Fax:570-321-8012
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045463-E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAE28798Medicare UPIN
PA847419Medicare ID - Type Unspecified