Provider Demographics
NPI:1104844133
Name:ISAACS, AYODELE T (MD)
Entity type:Individual
Prefix:DR
First Name:AYODELE
Middle Name:T
Last Name:ISAACS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AYODELE
Other - Middle Name:T
Other - Last Name:OLUGBEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:13 CRONIN RD
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-5289
Mailing Address - Country:US
Mailing Address - Phone:207-764-3457
Mailing Address - Fax:
Practice Address - Street 1:163 VAN BUREN RD
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3567
Practice Address - Country:US
Practice Address - Phone:207-498-3111
Practice Address - Fax:207-496-2631
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD15922207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1104844133Medicaid
MESX2262Medicare PIN