Provider Demographics
NPI:1316387038
Name:ISAAC, SAREPTA (DPM)
Entity type:Individual
Prefix:DR
First Name:SAREPTA
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 N TRADE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-1729
Mailing Address - Country:US
Mailing Address - Phone:704-841-4000
Mailing Address - Fax:704-841-4338
Practice Address - Street 1:428 N TRADE ST STE 100
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-1729
Practice Address - Country:US
Practice Address - Phone:704-841-4000
Practice Address - Fax:704-841-4338
Is Sole Proprietor?:No
Enumeration Date:2013-06-26
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80223213E00000X
TNDPM0000000774213E00000X
GAPOD001275213E00000X
NC844213E00000X
AL320213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003161380AMedicaid
AL174769Medicaid
GA202I483555Medicare PIN
AL174769Medicaid