Provider Demographics
NPI:1629066212
Name:BISHOP, DELINA HARSHA (MD)
Entity Type:Individual
Prefix:DR
First Name:DELINA
Middle Name:HARSHA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DELINA
Other - Middle Name:HARSHA
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1145 TIMBERBROOK LN
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-8308
Mailing Address - Country:US
Mailing Address - Phone:904-305-8617
Mailing Address - Fax:704-380-0986
Practice Address - Street 1:478 WILLIAMSON RD UNIT 202B
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8192
Practice Address - Country:US
Practice Address - Phone:704-664-1275
Practice Address - Fax:704-380-0986
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-08
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200401548207Q00000X, 207QB0002X, 208VP0000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5912020Medicaid
2076159Medicare PIN