Individual
JONATHAN SCOTT FISH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2470 LONGSTONE LN STE I, MARRIOTTSVILLE, MD 21104-1523
(410) 910-2300
(410) 740-9134
Mailing address
2470 LONGSTONE LN, STE I, MARRIOTTSVILLE, MD 21104-1523
(410) 910-2300
(410) 910-2310
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0051860
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
769210200
—
MD
01
—
B6100004
BC BS
DC
Enumeration date
08/31/2005
Last updated
11/14/2017
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