Provider Demographics
NPI:1366494734
Name:BISHAI, MAGDA A (MD)
Entity Type:Individual
Prefix:
First Name:MAGDA
Middle Name:A
Last Name:BISHAI
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 1:25 COMMUNICATIONS WAY
Mailing Address - Street 2:MACC-REVENUE CYCLE
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1866
Mailing Address - Country:US
Mailing Address - Phone:508-957-8664
Mailing Address - Fax:508-957-8677
Practice Address - Street 1:2 JAN SEBASTIAN WAY
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563
Practice Address - Country:US
Practice Address - Phone:508-833-8247
Practice Address - Fax:508-833-6535
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76407207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAF49304OtherUPIN #
MA3109046Medicaid
MAJ13442Medicare ID - Type UnspecifiedMEDICARE #