Provider Demographics
NPI:1760425052
Name:BISHAI, ADEL G (MD)
Entity Type:Individual
Prefix:
First Name:ADEL
Middle Name:G
Last Name:BISHAI
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 1:6 DOCTORS DR
Mailing Address - Street 2:EMPORIA MEDICAL ASSOCIATES PC
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-1240
Mailing Address - Country:US
Mailing Address - Phone:434-634-6101
Mailing Address - Fax:434-634-7117
Practice Address - Street 1:6 DOCTORS DR
Practice Address - Street 2:EMPORIA MEDICAL ASSOCIATES PC
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1240
Practice Address - Country:US
Practice Address - Phone:434-634-6101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101039644208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA187120OtherBLUE SHIELD
9534853OtherCIGNA
VA005699754Medicaid
B05231Medicare UPIN
080001221Medicare ID - Type Unspecified