Basic Information
| Provider Information | |||||||||
| NPI: | 1043286255 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BISHOP DANIELS | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 WATSON HILL RD | ||||||||
| Address2: | |||||||||
| City: | RAYMOND | ||||||||
| State: | NH | ||||||||
| PostalCode: | 030771864 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 25 HIGHLAND AVE | ||||||||
| Address2: | ANNA JAQUES HOSPITAL- EMERGENCY DEPT | ||||||||
| City: | NEWBURYPORT | ||||||||
| State: | MA | ||||||||
| PostalCode: | 019503867 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784631050 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2006 | ||||||||
| LastUpdateDate: | 04/18/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 225343 | MA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2107309 | 05 | MA | MEDICAID | J29190 | 01 | MA | BCBS OF MA | OTHER |