Provider Demographics
NPI: | 1760440663 |
---|---|
Name: | BISHOP, HARRY |
Entity Type: | Individual |
Prefix: | |
First Name: | HARRY |
Middle Name: | |
Last Name: | BISHOP |
Suffix: | |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | RR 1 BOX 5Q |
Mailing Address - Street 2: | |
Mailing Address - City: | BRIDGEPORT |
Mailing Address - State: | WV |
Mailing Address - Zip Code: | 26330-9303 |
Mailing Address - Country: | US |
Mailing Address - Phone: | |
Mailing Address - Fax: | |
Practice Address - Street 1: | 147 W MAIN ST |
Practice Address - Street 2: | |
Practice Address - City: | BRIDGEPORT |
Practice Address - State: | WV |
Practice Address - Zip Code: | 26330-1866 |
Practice Address - Country: | US |
Practice Address - Phone: | 304-842-4100 |
Practice Address - Fax: | 304-842-4100 |
Is Sole Proprietor?: | Not Answered |
Enumeration Date: | 2006-05-02 |
Last Update Date: | 2007-07-08 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WV | 12592 | 207RC0000X, 207RM1200X, 207U00000X, 207UN0901X, 207UN0902X, 207UN0903X, 2085B0100X, 2085N0700X, 2085P0229X, 2085R0001X, 2085R0202X, 2085R0203X, 2085R0204X, 2085U0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Not Answered | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
Not Answered | 207RM1200X | Allopathic & Osteopathic Physicians | Internal Medicine | Magnetic Resonance Imaging (MRI) |
Not Answered | 207U00000X | Allopathic & Osteopathic Physicians | Nuclear Medicine | |
Not Answered | 207UN0901X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology |
Not Answered | 207UN0902X | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Imaging & Therapy |
Not Answered | 207UN0903X | Allopathic & Osteopathic Physicians | Nuclear Medicine | In Vivo & In Vitro Nuclear Medicine |
Not Answered | 2085B0100X | Allopathic & Osteopathic Physicians | Radiology | Body Imaging |
Not Answered | 2085N0700X | Allopathic & Osteopathic Physicians | Radiology | Neuroradiology |
Not Answered | 2085P0229X | Allopathic & Osteopathic Physicians | Radiology | Pediatric Radiology |
Not Answered | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
Not Answered | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
Not Answered | 2085R0203X | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology |
Not Answered | 2085R0204X | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
Not Answered | 2085U0001X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Ultrasound |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | C35037 | Medicare UPIN |