1518585801 NPI number — KOLTEN P FISCHER MD

Table of content: KOLTEN P FISCHER MD (NPI 1518585801)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518585801 NPI number — KOLTEN P FISCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISCHER
Provider First Name:
KOLTEN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FISCHER
Provider Other First Name:
KOLTEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1518585801
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VCU HEALTH DEPARTMENT OF EMERGENCY MEDICINE, BOX 980401
Provider Second Line Business Mailing Address:
1250 E. MARSHALL ST
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23298-0401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
265 GRIFFIN ST E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54001-1439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-268-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/13/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  73970 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 81703 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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