Provider Demographics
NPI:1891008033
Name:BISHARA, JOHN BISHOY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BISHOY
Last Name:BISHARA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 PENNSYLVANIA AVE
Mailing Address - Street 2:STE 103
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25302-3389
Mailing Address - Country:US
Mailing Address - Phone:304-388-1552
Mailing Address - Fax:304-388-1565
Practice Address - Street 1:830 PENNSYLVANIA AVE STE 408
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302
Practice Address - Country:US
Practice Address - Phone:304-388-1552
Practice Address - Fax:304-388-1565
Is Sole Proprietor?:No
Enumeration Date:2010-07-16
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV33542080P0214X
CA20A152722080P0214X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0214XAllopathic & Osteopathic PhysiciansPediatricsPediatric Pulmonology