Provider Demographics
NPI:1841239753
Name:BIVINS, HAROLD A JR (MD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:A
Last Name:BIVINS
Suffix:JR
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 1:10330 N MERIDIAN ST # 300
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1024
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14710 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2800
Practice Address - Country:US
Practice Address - Phone:813-738-6691
Practice Address - Fax:813-816-0327
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3621207VM0101X
IN01069092A207VM0101X
GA030955207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201006820Medicaid
GA506482OtherBLUE CROSS BLUE SHIELD
SCG35680Medicaid
160051156OtherRAILROAD MEDICARE
582162071007OtherCHAMPUS
INP01307647OtherMEDICAR RR PTAN
GA003985711Medicaid
E19931Medicare UPIN
160051156OtherRAILROAD MEDICARE
160051156OtherRAILROAD MEDICARE