Provider Demographics
NPI:1659457950
Name:FISHER, MARK LOUIS (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:LOUIS
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 DIVIDING RD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-4324
Mailing Address - Country:US
Mailing Address - Phone:410-544-7352
Mailing Address - Fax:
Practice Address - Street 1:537 RITCHIE HWY STE 1C
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2930
Practice Address - Country:US
Practice Address - Phone:410-315-7715
Practice Address - Fax:410-315-7541
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical