Provider Demographics
NPI:1477750198
Name:BIOLA, JOHANNA FISHER (MD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:FISHER
Last Name:BIOLA
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 1:812 GORMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-3181
Mailing Address - Country:US
Mailing Address - Phone:304-637-0433
Mailing Address - Fax:304-637-0435
Practice Address - Street 1:812 GORMAN AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-3181
Practice Address - Country:US
Practice Address - Phone:304-637-0433
Practice Address - Fax:304-637-0435
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV22936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00621882OtherRAILROAD MEDICARE
WV3810012249Medicaid
WVCA7030OtherRAILROAD MEDICARE GROUP #
WV3810012249Medicaid
WVBI6037131Medicare PIN