Individual provider · NPI-1

Clarence Marvin Bishop, Surgical Assistant

Physician Assistant, Surgical · Bowie, MD

NPI number1912134792
StatusActive
Last updated in NPPESJun 18, 2009

Details

NPI
1912134792
Entity type
Individual (NPI-1)
Name
Mr. Clarence Marvin Bishop
Credential
Surgical Assistant
Sex
Male
Sole proprietor
Yes
Enumeration date
Jun 18, 2009
Last updated
Jun 18, 2009

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363AS0400X Physician Assistant, Surgical––Yes

Practice location

5505 Wrights Endeavor Dr
Bowie, MD 20720-3383

Phone 301-805-2260 · Fax 301-805-2260

Mailing address

5505 Wrights Endeavor Dr
Bowie, MD 20720-3383

Phone 301-805-2260 · Fax 301-805-2260

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