Healthcare Provider Details

I. General information

NPI: 1750418315
Provider Name (Legal Business Name): THOMAS H BISHOP M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 S MAIN ST
BLACKSBURG VA
24060-7017
US

IV. Provider business mailing address

2001 S MAIN ST SUITE 1
BLACKSBURG VA
24060-6678
US

V. Phone/Fax

Practice location:
  • Phone: 540-951-4992
  • Fax: 540-951-0302
Mailing address:
  • Phone: 540-951-4992
  • Fax: 540-951-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101238670
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number0101238670
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: