Provider Demographics
NPI:1457491532
Name:ISAACS, ANDREA GAIL (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:GAIL
Last Name:ISAACS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 STATE ST APT 365
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-2773
Mailing Address - Country:US
Mailing Address - Phone:646-234-5268
Mailing Address - Fax:
Practice Address - Street 1:MTS 490 BLUE HILLS AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06112
Practice Address - Country:US
Practice Address - Phone:860-714-2647
Practice Address - Fax:860-714-8517
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY212109207RP1001X, 207R00000X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ25MA0762130OtherMEDICAL LICENSE #
NJ25MA0762130OtherMEDICAL LICENSE #
NJH92285Medicare UPIN