Basic Information
| Provider Information | |||||||||
| NPI: | 1891008033 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BISHARA | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | BISHOY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 830 PENNSYLVANIA AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 253023389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881552 | ||||||||
| FaxNumber: | 3043881565 | ||||||||
| Practice Location | |||||||||
| Address1: | 830 PENNSYLVANIA AVE STE 408 | ||||||||
| Address2: | |||||||||
| City: | CHARLESTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043881552 | ||||||||
| FaxNumber: | 3043881565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2010 | ||||||||
| LastUpdateDate: | 04/06/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0214X | 3354 | WV | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology | 2080P0214X | 20A15272 | CA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Pulmonology |
No ID Information.