Provider Demographics
NPI:1134139082
Name:BISBING, RICHARD GROVER (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:GROVER
Last Name:BISBING
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:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:SHERMANS DALE
Mailing Address - State:PA
Mailing Address - Zip Code:17090-0276
Mailing Address - Country:US
Mailing Address - Phone:717-582-2090
Mailing Address - Fax:717-582-7090
Practice Address - Street 1:4570 VALLEY RD
Practice Address - Street 2:
Practice Address - City:SHERMANS DALE
Practice Address - State:PA
Practice Address - Zip Code:17090-0276
Practice Address - Country:US
Practice Address - Phone:717-582-2090
Practice Address - Fax:717-582-7090
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049443L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50026519OtherCAPITAL BLUE CROSS
PA000426964OtherHIGHMARK
PA001845726 005Medicaid
PAF45466Medicare UPIN
PA50026519OtherCAPITAL BLUE CROSS