Provider Demographics
NPI:1316059306
Name:FELAHY, ISAM (MD)
Entity type:Individual
Prefix:
First Name:ISAM
Middle Name:
Last Name:FELAHY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ISAM
Other - Middle Name:
Other - Last Name:FELAHY MD INC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2800 N CALIFORNIA ST
Mailing Address - Street 2:SUITE 15
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-3757
Mailing Address - Country:US
Mailing Address - Phone:209-466-3457
Mailing Address - Fax:209-466-1229
Practice Address - Street 1:2800 N CALIFORNIA ST
Practice Address - Street 2:SUITE 15
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-3757
Practice Address - Country:US
Practice Address - Phone:209-466-3457
Practice Address - Fax:209-466-1229
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25226208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1109416Medicaid
00A252260Medicare ID - Type Unspecified
CA1109416Medicaid