Provider Demographics
NPI:1871558510
Name:FLEISHMAN, JOHN ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
Last Name:FLEISHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4148 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:KETTERING
Mailing Address - State:OH
Mailing Address - Zip Code:45429-1640
Mailing Address - Country:US
Mailing Address - Phone:937-643-4049
Mailing Address - Fax:
Practice Address - Street 1:1520 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45409-2698
Practice Address - Country:US
Practice Address - Phone:937-223-1279
Practice Address - Fax:937-223-9979
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35059036207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0101535Medicaid
OHA06449Medicare UPIN
OH0651091Medicare ID - Type UnspecifiedMEDICARE
OH1086550001Medicare NSC