1396785598 NPI number — MARK NEAL ISAACS M.D.

Table of content: MARK NEAL ISAACS M.D. (NPI 1396785598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396785598 NPI number — MARK NEAL ISAACS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAACS
Provider First Name:
MARK
Provider Middle Name:
NEAL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396785598
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
01/04/2023
NPI Reactivation Date:
01/09/2023

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
630 THOMAS L BERKLEY WAY
Provider Second Line Business Mailing Address:
APT 508
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94612-1865
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-569-1310
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1981 N BROADWAY STE 270
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WALNUT CREEK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94596-3886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-932-6442
Provider Business Practice Location Address Fax Number:
925-932-6260
Provider Enumeration Date:
06/07/2006

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: 207Q00000X , with the licence number:  G32292 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: G32292 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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