Provider Demographics
NPI:1487645115
Name:FISCHER, GARY JAY (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:JAY
Last Name:FISCHER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1317 N. ELM STREET
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1023
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1317 N. ELM ST.
Practice Address - Street 2:SUITE 1B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1023
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC194732085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1081OtherPARTNERS
NC300065907OtherRAILROAD MEDICARE
VA1487645115OtherVIRGINIA MEDICAID
NC1600269OtherUNITED HEALTHCARE
NC32090OtherBLUE CROSS BLUE SHIELD
NC8932090Medicaid
NC70509OtherMEDCOST
NC70509OtherMEDCOST
NC1600269OtherUNITED HEALTHCARE