Provider Demographics
NPI:1861475311
Name:BISSELL, NOELLE S (MD)
Entity Type:Individual
Prefix:DR
First Name:NOELLE
Middle Name:S
Last Name:BISSELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 TURNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:RINER
Mailing Address - State:VA
Mailing Address - Zip Code:24149-2571
Mailing Address - Country:US
Mailing Address - Phone:540-381-9328
Mailing Address - Fax:
Practice Address - Street 1:210 S. PEPPER STREET SUITE A
Practice Address - Street 2:NEW RIVER HEALTH DISTRICT
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-585-3304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-230454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010005957Medicaid
VA010005957Medicaid
002057C40Medicare PIN