Provider Demographics
NPI:1316050693
Name:FLEISCHER, SCOTT ALLAN (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ALLAN
Last Name:FLEISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3403
Mailing Address - Country:US
Mailing Address - Phone:215-793-4546
Mailing Address - Fax:215-793-9007
Practice Address - Street 1:455 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3403
Practice Address - Country:US
Practice Address - Phone:215-793-4546
Practice Address - Fax:215-793-9007
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2017-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021341E2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
031931JM2OtherMEDICARE ID
031931JM2OtherMEDICARE ID