Basic Information
| Provider Information | |||||||||
| NPI: | 1598849788 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CRAIG FISCHER, MD MEDICAL CORPORATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2006 DWIGHT WAY STE 304 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108432220 | ||||||||
| FaxNumber: | 5108432227 | ||||||||
| Practice Location | |||||||||
| Address1: | 2006 DWIGHT WAY STE 304 | ||||||||
| Address2: | |||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042633 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5108432220 | ||||||||
| FaxNumber: | 5108432227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 08/06/2007 | ||||||||
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| AuthorizedOfficialLastName: | FISCHER | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5108432220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | G025733 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | G025733 | 01 | CA | STATE LICENSE | OTHER |