Provider Demographics
NPI:1194727917
Name:ISAAC, GHADA (MD)
Entity type:Individual
Prefix:DR
First Name:GHADA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GHADA
Other - Middle Name:
Other - Last Name:ISHAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 35652
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85740-5652
Mailing Address - Country:US
Mailing Address - Phone:520-219-2939
Mailing Address - Fax:480-839-4727
Practice Address - Street 1:6336 N PINNACLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-3535
Practice Address - Country:US
Practice Address - Phone:520-219-2939
Practice Address - Fax:480-839-4727
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232129207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GI03656R10OtherEMPIRE BLUE CROSS
000416905001OtherBLUE SHIELD NENY
GI03656R20OtherEMPIRE BLUE CROSS
10083979OtherCDPHP
232129-7WOtherWORKERS COMP
NY02552918Medicaid
050502000000OtherFIDELIS
232129-7WOtherNO FAULT
3656ROtherEMPIRE BLUE CROSS
000416905003OtherBLUE SHIELD NENY
232129OtherTRICARE NORTH REGION
4126832OtherMVP
NY02552918Medicaid
4126832OtherMVP
3656ROtherEMPIRE BLUE CROSS