Basic Information
| Provider Information | |||||||||
| NPI: | 1356688543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | MATTHEW | ||||||||
| MiddleName: | I | ||||||||
| NamePrefix: | |||||||||
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| Credential: | QMHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5050 MADISON RD | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452271491 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132722800 | ||||||||
| FaxNumber: | 5136317484 | ||||||||
| Practice Location | |||||||||
| Address1: | 1071 TONG HOLLOW RD | ||||||||
| Address2: | |||||||||
| City: | BAINBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456121500 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406343094 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2013 | ||||||||
| LastUpdateDate: | 06/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | N | Other Service Providers | Specialist | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.