Basic Information
Provider Information | |||||||||
NPI: | 1730165002 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FLEISCHER | ||||||||
FirstName: | ALAN | ||||||||
MiddleName: | BERNARD | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: | JR. | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 636256 | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 452636256 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5135855505 | ||||||||
FaxNumber: | 5135855511 | ||||||||
Practice Location | |||||||||
Address1: | 3130 HIGHLAND AVE | ||||||||
Address2: |   | ||||||||
City: | CINCINNATI | ||||||||
State: | OH | ||||||||
PostalCode: | 45219 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5135843686 | ||||||||
FaxNumber: | 5134757636 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/19/2005 | ||||||||
LastUpdateDate: | 07/24/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 48432 | KY | N |   | Allopathic & Osteopathic Physicians | Dermatology |   | 207N00000X | 35.133947 | OH | Y |   | Allopathic & Osteopathic Physicians | Dermatology |   | 207N00000X | 33040 | NC | N |   | Allopathic & Osteopathic Physicians | Dermatology |   |
ID Information
ID | Type | State | Issuer | Description | 32528 | 01 |   | BCBS | OTHER | Q33040 | 05 | SC |   | MEDICAID | 2962 | 01 |   | PARTNERS | OTHER | 195754000 | 05 | WV |   | MEDICAID | 48432 | 01 | KY | KENTUCKY BOARD OF MEDICAL LICENSURE | OTHER | 5940184 | 05 | VA |   | MEDICAID | 63998 | 01 |   | MEDCOST | OTHER | 8932528 | 05 | NC |   | MEDICAID | 4618265 | 01 |   | AETNA | OTHER |