Healthcare Provider Details

I. General information

NPI: 1376557637
Provider Name (Legal Business Name): HIRUY G BISHAW M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 02/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8118 GOOD LUCK RD
LANHAM MD
20706-3595
US

IV. Provider business mailing address

8600 GARNET ROCK GATE
LAUREL MD
20723-4902
US

V. Phone/Fax

Practice location:
  • Phone: 301-552-8130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0063631
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: