Provider Demographics
NPI:1053373142
Name:FISHMAN, ERIC P (PHD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:P
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 TILBURY AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2517
Mailing Address - Country:US
Mailing Address - Phone:304-281-8442
Mailing Address - Fax:412-428-9744
Practice Address - Street 1:2702 TILBURY AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2517
Practice Address - Country:US
Practice Address - Phone:304-281-8442
Practice Address - Fax:412-428-9744
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV612174400000X
PAPS006251L174400000X
103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001747805OtherBLUE CROSS/BLUE SHIELD
WV612AOtherHEALTH PLAN OF UPPER OHIO
WV612AOtherHEALTH PLAN OF UPPER OHIO
WVW17261Medicare UPIN