1194727917 NPI number — DR. GHADA ISAAC M.D.

Table of content: DR. GHADA ISAAC M.D. (NPI 1194727917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194727917 NPI number — DR. GHADA ISAAC M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAAC
Provider First Name:
GHADA
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ISHAK
Provider Other First Name:
GHADA
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1194727917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35652
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85740-5652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-219-2939
Provider Business Mailing Address Fax Number:
480-839-4727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6336 N PINNACLE RIDGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85718-3535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-219-2939
Provider Business Practice Location Address Fax Number:
480-839-4727
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  232129 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GI03656R10 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000416905001 . This is a "BLUE SHIELD NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: GI03656R20 . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10083979 . This is a "CDPHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232129-7W . This is a "WORKERS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 02552918 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 050502000000 . This is a "FIDELIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232129-7W . This is a "NO FAULT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3656R . This is a "EMPIRE BLUE CROSS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000416905003 . This is a "BLUE SHIELD NENY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232129 . This is a "TRICARE NORTH REGION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4126832 . This is a "MVP" identifier . This identifiers is of the category "OTHER".




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