Provider Demographics
NPI:1215145040
Name:FISHER, KYLE W (MD)
Entity type:Individual
Prefix:DR
First Name:KYLE
Middle Name:W
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:1650 HUNTINGDON PIKE STE 223
Mailing Address - Street 2:
Mailing Address - City:MEADOWBROOK
Mailing Address - State:PA
Mailing Address - Zip Code:19046-8006
Mailing Address - Country:US
Mailing Address - Phone:215-938-5970
Mailing Address - Fax:215-938-5973
Practice Address - Street 1:1650 HUNTINGDON PIKE STE 223
Practice Address - Street 2:
Practice Address - City:MEADOWBROOK
Practice Address - State:PA
Practice Address - Zip Code:19046-8006
Practice Address - Country:US
Practice Address - Phone:215-938-5970
Practice Address - Fax:215-938-5973
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD432243207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102114415Medicaid