Provider Demographics
NPI:1992717771
Name:ISAACS, STUART N (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:N
Last Name:ISAACS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3900 WOODLAND AVE
Mailing Address - Street 2:VA
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-4551
Mailing Address - Country:US
Mailing Address - Phone:215-573-7515
Mailing Address - Fax:215-349-5111
Practice Address - Street 1:3900 WOODLAND AVE
Practice Address - Street 2:VA
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-4551
Practice Address - Country:US
Practice Address - Phone:215-573-7515
Practice Address - Fax:215-349-5111
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037298E207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA145759Medicaid
PA001457959OtherNEW MPI PROVID. #
PA145759Medicaid
PA748399Medicare PIN
PAIS748399Medicare PIN