Douglas Fisher, P.A.C.

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

23-013281 Issued in NY

Practice address

117 Hampton Rd
Southampton, NY 11968-4923

Phone

(631) 287-8600

Fax

(631) 204-1585

NPI assigned

Jun 21, 2005

Last updated

Mar 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eastern Suffolk Urology PC

  • Urology Physician
  • Southampton, NY
  • NPI 1558498766
  NPD (past)
• Meeting House Lane Medical Practice PC

  • Internal Medicine Physician
  • Southampton, NY
  • NPI 1902088495
  NPD (past)
• Brown Urology, Inc.

  • Urology Physician
  • Providence, RI
  • NPI 1467973099
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1245235761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 273",
            "city": "EAST MARION",
            "state": "NY",
            "postal_code": "11939",
            "telephone_number": "631-287-8600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 HAMPTON RD",
            "city": "SOUTHAMPTON",
            "state": "NY",
            "postal_code": "119684923",
            "telephone_number": "631-287-8600",
            "fax_number": "631-204-1585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "DOUGLAS",
        "credential": "P.A.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "RI",
            "license": "PA00256",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "23-013281",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "30584",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles Falzarano, MD
• Robert Edward Fear, M.D.
• Allen Lawrence Fein, M.D.
• Annie Feng, MD
• Rajeev Santiago Fernando, M.D
• Cristina Fonalledas, FNP
• Kristen Anne Forte, ANP-BC, CRNFA
• Kimberly D. Foster, PHARMACIST
• Francis Yoo, D.O., P.C.
• Michael Frenkel

• Medical Physician Assistant in Southampton, NY
• Providers in Southampton, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.