Provider Demographics
NPI:1578533766
Name:BISHOP, MARVIN A (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:A
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 1:218 S MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2494
Mailing Address - Country:US
Mailing Address - Phone:859-745-2861
Mailing Address - Fax:859-745-1978
Practice Address - Street 1:218 S MAPLE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2494
Practice Address - Country:US
Practice Address - Phone:859-745-2861
Practice Address - Fax:859-745-1978
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35957207RE0101X, 207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64066186Medicaid
KY64066186Medicaid
0761302Medicare ID - Type Unspecified