Provider Demographics
NPI:1558378299
Name:BIBOSO, JOSE ARCADIO (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ARCADIO
Last Name:BIBOSO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:J
Other - Middle Name:ARCADIO
Other - Last Name:BIBOSO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:5125 JONESTOWN RD STE 105
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-2987
Practice Address - Country:US
Practice Address - Phone:717-943-1566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD422152207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102988OtherGEISINGER
PA204528OtherJOHNS HOPKINS
PA101731497Medicaid
MD889308OtherCAREFIRST MD BCBS
PA1897419OtherHIGHMARK BLUE SHIELD
PA2764670000OtherAMERIHEALTH 65 PA
PA7344537OtherAETNA
PA101731497Medicaid
PAP00341503Medicare PIN
PA1897419OtherHIGHMARK BLUE SHIELD