Provider Demographics
NPI:1215108428
Name:FLEISIG, NORBERT (MD)
Entity type:Individual
Prefix:DR
First Name:NORBERT
Middle Name:
Last Name:FLEISIG
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:ONE RANDALL SQUARE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02904
Mailing Address - Country:US
Mailing Address - Phone:401-521-3292
Mailing Address - Fax:401-521-5424
Practice Address - Street 1:ONE RANDALL SQUARE
Practice Address - Street 2:SUITE 304
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02904
Practice Address - Country:US
Practice Address - Phone:401-521-3292
Practice Address - Fax:401-521-5424
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03886208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
C89835Medicare UPIN