Provider Demographics
NPI:1659304483
Name:BISHOP, THERESA S (MD)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:S
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MONUMENT ST
Mailing Address - Street 2:SUITE 224
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-2638
Mailing Address - Country:US
Mailing Address - Phone:864-227-3908
Mailing Address - Fax:864-227-2668
Practice Address - Street 1:600 MONUMENT ST
Practice Address - Street 2:SUITE 224
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-2638
Practice Address - Country:US
Practice Address - Phone:864-227-3908
Practice Address - Fax:864-227-2668
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20-220692084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN01253Medicaid
SCG66585Medicare UPIN
SC5654Medicare PIN