Basic Information
Provider Information
NPI: 1164869392
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FISHER
FirstName: RACHAEL
MiddleName: LEIGH
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 776351
Address2:  
City: CHICAGO
State: IL
PostalCode: 606776351
CountryCode: US
TelephoneNumber: 5025889490
FaxNumber: 5022725116
Practice Location
Address1: 1 MEDICAL CENTER BLVD STE 333
Address2:  
City: CHESTER
State: PA
PostalCode: 19013
CountryCode: US
TelephoneNumber: 6106198300
FaxNumber: 6108729221
Other Information
ProviderEnumerationDate: 05/29/2013
LastUpdateDate: 02/22/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 02/22/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207V00000XOS017480PAY Allopathic & Osteopathic PhysiciansObstetrics & Gynecology 

No ID Information.


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