Provider Demographics
NPI:1073925764
Name:BISHAR, RIMA (MD)
Entity Type:Individual
Prefix:
First Name:RIMA
Middle Name:
Last Name:BISHAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:SUITE 467 MOB EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3434
Mailing Address - Country:US
Mailing Address - Phone:610-896-7328
Mailing Address - Fax:610-896-6171
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:SUITE 467 MOB EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-896-7328
Practice Address - Fax:610-896-6171
Is Sole Proprietor?:No
Enumeration Date:2014-05-29
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT206005390200000X
PAMD460022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program