Active NPI
Michael Dennis Fidler, M.D.
- Psychiatry Physician
- San Pablo, CA
National Provider Identifier
1336489061
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- C34092
- Practice address
- 2523 El Portal Dr
Suite 101
San Pablo, CA 94806-3305 - Phone
- (510) 215-3700
- Fax
- (510) 215-3791
- NPI assigned
- Feb 16, 2013
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | C34092 | CA | Primary |
Addresses
Primary practice location
2523 El Portal Dr
Suite 101
San Pablo, CA 94806-3305
Mailing address
2523 El Portal Dr
Suite 101
San Pablo, CA 94806-3305
Phone (510) 215-3700
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 34092 | CA | MD | Endodontist |
| C34092 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1360972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1410480000000",
"number": "1336489061",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2523 EL PORTAL DR",
"address_2": "SUITE 101",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063305",
"telephone_number": "510-215-3700",
"fax_number": "510-215-3791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2523 EL PORTAL DR",
"address_2": "SUITE 101",
"city": "SAN PABLO",
"state": "CA",
"postal_code": "948063305",
"telephone_number": "510-215-3700",
"fax_number": "510-215-3791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FIDLER",
"first_name": "MICHAEL",
"middle_name": "DENNIS",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-02-16",
"last_updated": "2014-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "C34092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pablo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.