Provider Demographics
NPI:1760444186
Name:BISHARA, HANY M (MD)
Entity type:Individual
Prefix:
First Name:HANY
Middle Name:M
Last Name:BISHARA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60280
Mailing Address - Street 2:MCKESSON CORP
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29419-0280
Mailing Address - Country:US
Mailing Address - Phone:843-569-4020
Mailing Address - Fax:770-237-4980
Practice Address - Street 1:833 CAMPBELL HILL ST
Practice Address - Street 2:SUITE 111
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060
Practice Address - Country:US
Practice Address - Phone:770-424-7800
Practice Address - Fax:770-426-8572
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2008-02-22
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Provider Licenses
StateLicense IDTaxonomies
GA032874207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA450161OtherBLUE CROSS
GA00531572AMedicaid
GA220020959OtherRAILROAD MEDICARE
GA22BDCCHMedicare PIN
GA220020959OtherRAILROAD MEDICARE