Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301102738 | MI |
N | 208000000X | Pediatrician | MD463876 | PA |
Y | 2080P0204X | Pediatric Emergency Doctor | 282515 | MA |
N | 2080P0204X | Pediatric Emergency Doctor | MT212545 | PA |
NPI | 1235574781 |
---|---|
Provider Name | Jason Fischer |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/05/2013 |
Last Update Date | 12/07/2021 |