Provider Demographics
NPI:1932373198
Name:BISHARA, ERENY MAGDY (DO)
Entity Type:Individual
Prefix:
First Name:ERENY
Middle Name:MAGDY
Last Name:BISHARA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 MORRIS ST 201
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1853
Mailing Address - Country:US
Mailing Address - Phone:304-388-7700
Mailing Address - Fax:304-388-7755
Practice Address - Street 1:415 MORRIS ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1842
Practice Address - Country:US
Practice Address - Phone:304-388-7700
Practice Address - Fax:304-388-7755
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2888207XX0801X, 207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028451700001Medicaid
PA298875Medicare PIN