Individual
DONALD A FISCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
280 PATTONSVILLE RD, JACKSON, OH 45640-9452
(740) 395-8805
(740) 395-8855
Mailing address
90 JACKSON PIKE, GALLIPOLIS, OH 45631-1560
(740) 395-8805
(740) 395-8855
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34-00-2714
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000007643
ANTHEM BCBS
—
01
—
000000174815
UNISON MEDICAID
OH
01
—
001714054
MOUNTAIN STATE BCBS
—
05
—
0043340000
—
WV
01
—
080040481
RR MEDICARE
—
01
—
0823676
MOLINA MEDICAID
OH
05
—
0823676
—
OH
01
—
310917085037
CARESOURCE MEDICAID
OH
Enumeration date
05/25/2006
Last updated
08/07/2014
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