Provider Demographics
NPI:1669616694
Name:BISHOP, BARLA R (CNM)
Entity type:Individual
Prefix:MRS
First Name:BARLA
Middle Name:R
Last Name:BISHOP
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:BARLA
Other - Middle Name:R
Other - Last Name:ABRAHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNM MS
Mailing Address - Street 1:230 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-1123
Mailing Address - Country:US
Mailing Address - Phone:413-789-6800
Mailing Address - Fax:413-789-5171
Practice Address - Street 1:230 MAIN ST
Practice Address - Street 2:
Practice Address - City:AGAWAM
Practice Address - State:MA
Practice Address - Zip Code:01001-1838
Practice Address - Country:US
Practice Address - Phone:413-789-6800
Practice Address - Fax:413-789-5171
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2310316367A00000X
CT365367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110117937AMedicaid