Provider Demographics
NPI:1588758718
Name:FISCHBACH, NEAL A (MD)
Entity type:Individual
Prefix:MR
First Name:NEAL
Middle Name:A
Last Name:FISCHBACH
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 1:15 CORPORATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611
Mailing Address - Country:US
Mailing Address - Phone:203-459-0262
Mailing Address - Fax:203-459-0264
Practice Address - Street 1:15 CORPORATE DRIVE
Practice Address - Street 2:
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611
Practice Address - Country:US
Practice Address - Phone:203-459-0262
Practice Address - Fax:203-459-0264
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT042999207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2V6556OtherHEALTHNET
P3597961OtherOXFORD
CT010042999CT01OtherANTHEM
CT001429994Medicaid
CT830000147Medicare ID - Type Unspecified
CT010042999CT01OtherANTHEM