Provider Demographics
NPI:1366586810
Name:FISHKIN, RALPH ELLIOTT (D,O,)
Entity type:Individual
Prefix:DR
First Name:RALPH
Middle Name:ELLIOTT
Last Name:FISHKIN
Suffix:
Gender:M
Credentials:D,O,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRAMERCY RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2904
Mailing Address - Country:US
Mailing Address - Phone:610-667-3131
Mailing Address - Fax:
Practice Address - Street 1:171 GRAMERCY RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2904
Practice Address - Country:US
Practice Address - Phone:610-667-3789
Practice Address - Fax:610-667-3789
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2017-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002372L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOS002372LOtherSTATE LICENSE
PAOS002372LOtherSTATE LICENSE
PA121003Medicare ID - Type Unspecified