Basic Information
| Provider Information | |||||||||
| NPI: | 1902815814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEISCHMAN | ||||||||
| FirstName: | ROGER | ||||||||
| MiddleName: | ALAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | B412 VA HOSPITAL COOPER DRIVE | ||||||||
| Address2: | INTERNAL MEDICINE | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405022142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592576006 | ||||||||
| FaxNumber: | 8592576002 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 ROSE STREET CC180A ROACH BLDG. | ||||||||
| Address2: | UK HEMATOLOGY CLINIC | ||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405360093 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592576006 | ||||||||
| FaxNumber: | 8592576002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2006 | ||||||||
| LastUpdateDate: | 09/17/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 29871 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | 29871 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | 29871 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207ZH0000X | 29871 | KY | N | Allopathic & Osteopathic Physicians | Pathology | Hematology | 207RH0000X | 29871 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 64298714 | 05 | KY | MEDICAID |