Provider Demographics
NPI:1194995324
Name:FREDRICK A ISAACS MD PC
Entity type:Organization
Organization Name:FREDRICK A ISAACS MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRICK
Authorized Official - Middle Name:ARTHUR
Authorized Official - Last Name:ISAACS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-598-8500
Mailing Address - Street 1:3801 INTERNATIONAL DR
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1550
Mailing Address - Country:US
Mailing Address - Phone:301-598-8500
Mailing Address - Fax:301-598-1787
Practice Address - Street 1:3801 INTERNATIONAL DR
Practice Address - Street 2:SUITE 208
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1550
Practice Address - Country:US
Practice Address - Phone:301-598-8500
Practice Address - Fax:301-598-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054918174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5974020Medicaid
MD5974020Medicaid
MDD02179Medicare UPIN
MD0359260002Medicare NSC