Basic Information
| Provider Information | |||||||||
| NPI: | 1073518056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | J | ||||||||
| MiddleName: | RUSH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 4735 OGLETOWN STANTON RD | ||||||||
| Address2: | STE 3302 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197138000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 3026234289 | ||||||||
| Practice Location | |||||||||
| Address1: | 4735 OGLETOWN STANTON RD | ||||||||
| Address2: | STE 3302 | ||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197138000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026234144 | ||||||||
| FaxNumber: | 3026234289 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2005 | ||||||||
| LastUpdateDate: | 02/24/2015 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XS0117X | C10005347 | DE | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Surgery of the Spine |
ID Information
| ID | Type | State | Issuer | Description | 0512017000 | 01 | DE | AMERIHEALTH/KEYSTONE | OTHER | 200040677 | 01 | DE | RAILROAD MEDICARE | OTHER | 2291465 | 01 | DE | AETNA HMO | OTHER | 5579793001 | 01 | DE | CIGNA | OTHER | 2613 | 01 | DE | MID-ATLANTIC | OTHER | G37821 | 01 | DE | COVENTRY | OTHER | 1000034633 | 05 | DE | MEDICAID | 373895 | 01 | DE | INDEPENDENCE BC/PC | OTHER | 510399378 | 01 | DE | BCBS | OTHER | 5665641 | 01 | DE | AETNA PPO | OTHER |