MEDICARE: DEBORAH ELAINE BISHOP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	MD056630L	PA

General Provider Information

NPI Number	:	1093794000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH ELAINE BISHOP MD

Provider Business Mailing Address
First Line	:	9984 MARTIN AVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-1527
Country	:	US
Telephone Number	:	814-774-3495
Fax Number	:	814-774-3497

Provider Business Practice Location Address
First Line	:	9984 MARTIN AVE
Second Line	:
City	:	LAKE CITY
State	:	PA
Zip	:	16423-1527
Country	:	US
Telephone Number	:	814-774-3495
Fax Number	:	814-774-3497

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/26/2008

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