Provider Demographics
NPI:1083601629
Name:BISHOP, HARRY L (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:L
Last Name:BISHOP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PARKSIDE DR STE 331
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1922
Mailing Address - Country:US
Mailing Address - Phone:865-392-3400
Mailing Address - Fax:865-392-3449
Practice Address - Street 1:10800 PARKSIDE DR STE 331
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1922
Practice Address - Country:US
Practice Address - Phone:865-392-3400
Practice Address - Fax:865-392-3449
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN13239207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ018870Medicaid
TNB04235Medicare UPIN
TN103I060785Medicare PIN
TN103I066491Medicare PIN
TN3186261Medicare PIN
110038581Medicare PIN
P00841507Medicare PIN