Provider Demographics
NPI:1427146224
Name:ISAAC, JOSEPH WA (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:WA
Last Name:ISAAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:664 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-4818
Mailing Address - Country:US
Mailing Address - Phone:757-397-5804
Mailing Address - Fax:
Practice Address - Street 1:664 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-4818
Practice Address - Country:US
Practice Address - Phone:757-397-5804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026415207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB05222Medicare UPIN