1487618252 NPI number — DAVID M BISHAI MD

Table of content: ELIZABETH MILLINER BCBA (NPI 1003490707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487618252 NPI number — DAVID M BISHAI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BISHAI
Provider First Name:
DAVID
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487618252
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7402 YORK RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-7532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-821-7471
Provider Business Mailing Address Fax Number:
410-821-9582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7601 OSLER DR
Provider Second Line Business Practice Location Address:
SAINT JOSEPH MEDICAL CENTER
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-7700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-337-1226
Provider Business Practice Location Address Fax Number:
410-337-1118
Provider Enumeration Date:
04/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  D0051126 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 941711700 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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