Provider Demographics
NPI:1801861547
Name:BISHARAT, KATHERINE BAYARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:BAYARD
Last Name:BISHARAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6815 FAIR OAKS BLVD
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3868
Mailing Address - Country:US
Mailing Address - Phone:916-481-4374
Mailing Address - Fax:916-481-4307
Practice Address - Street 1:6815 FAIR OAKS BLVD
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3868
Practice Address - Country:US
Practice Address - Phone:916-481-4374
Practice Address - Fax:916-481-4307
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAO448709207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD92202Medicare UPIN