Provider Demographics
NPI:1285608455
Name:FISHBACK, NANCY FAY (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:FAY
Last Name:FISHBACK
Suffix:
Gender:F
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 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-388-3322
Mailing Address - Fax:757-388-4190
Practice Address - Street 1:600 GRESHAM DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1904
Practice Address - Country:US
Practice Address - Phone:757-388-3322
Practice Address - Fax:757-388-4190
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057434207R00000X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAPAROtherCIGNA
VA005811180Medicaid
VA28029OtherSENTARA OPTIMA
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC0616NOtherNC BC/BS
NC790616NMedicaid
VAPAROtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherAETNA
VAPAROtherMULTIPLAN
VAPAROtherUSA MANAGED CARE
VAPAROtherCORVEL/CORCARE
VA243424OtherANTHEM
263651OtherUHC/MAMSI
VAPAROtherVIRGINIA PREMIER HEALTH
VA243424OtherANTHEM
263651OtherUHC/MAMSI
VAPAROtherTRICARE/CHAMPUS