Provider Demographics
NPI:1417953043
Name:FISHMAN, SIDNEY MARK (MD)
Entity type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:MARK
Last Name:FISHMAN
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 1:40 OCEAN VISTA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-705-8992
Mailing Address - Fax:562-596-5703
Practice Address - Street 1:40 OCEAN VISTA
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-705-8992
Practice Address - Fax:562-596-5703
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2024-12-04
Deactivation Date:2006-04-04
Deactivation Code:
Reactivation Date:2006-06-28
Provider Licenses
StateLicense IDTaxonomies
CAAF7229455207YX0905X, 207YX0602X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G305900Medicaid
CAW11893Medicare ID - Type Unspecified
CAA44476Medicare UPIN