Healthcare Provider Details

I. General information

NPI: 1578533766
Provider Name (Legal Business Name): MARVIN A BISHOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD BLDG A
PIKEVILLE KY
41501-1602
US

IV. Provider business mailing address

PO BOX 432
PIKEVILLE KY
41502-0432
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-2208
  • Fax: 606-218-7508
Mailing address:
  • Phone: 606-430-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35957
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35957
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number35957
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: