Provider Demographics
NPI:1528049830
Name:PETER J ISAAC DO LLC
Entity type:Organization
Organization Name:PETER J ISAAC DO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:ISAAC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-820-5703
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1275 S CEDAR CREST BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-820-5703
Practice Address - Fax:610-433-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012579850008Medicaid
50036424OtherCBC
1615553OtherHIGHMARK BLUE SHIELD
DB9519OtherRR MEDICARE
20033447OtherAMERIHEALTH MERCY
2294393000OtherIBC
PA0012579850004Medicaid