Provider Demographics
NPI:1144361973
Name:BISHOP, ELENA FOMICHEVA (MD)
Entity type:Individual
Prefix:DR
First Name:ELENA
Middle Name:FOMICHEVA
Last Name:BISHOP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ELENA
Other - Middle Name:VENIAMINOVNA
Other - Last Name:FOMICHEVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5958 NORTHLAND RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46228-1072
Mailing Address - Country:US
Mailing Address - Phone:317-293-4799
Mailing Address - Fax:317-491-6334
Practice Address - Street 1:350 WEST 11TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202
Practice Address - Country:US
Practice Address - Phone:317-491-6336
Practice Address - Fax:317-491-6334
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01059075A207ZP0102X
FLME158613207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology