Basic Information
| Provider Information | |||||||||
| NPI: | 1194727917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISAAC | ||||||||
| FirstName: | GHADA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | ISHAK | ||||||||
| OtherFirstName: | GHADA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 35652 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857405652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202192939 | ||||||||
| FaxNumber: | 4808394727 | ||||||||
| Practice Location | |||||||||
| Address1: | 6336 N PINNACLE RIDGE DR | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857183535 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5202192939 | ||||||||
| FaxNumber: | 4808394727 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 11/02/2017 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 232129 | NY | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | GI03656R10 | 01 | EMPIRE BLUE CROSS | OTHER | 000416905001 | 01 | BLUE SHIELD NENY | OTHER | GI03656R20 | 01 | EMPIRE BLUE CROSS | OTHER | 10083979 | 01 | CDPHP | OTHER | 232129-7W | 01 | WORKERS COMP | OTHER | 02552918 | 05 | NY | MEDICAID | 050502000000 | 01 | FIDELIS | OTHER | 232129-7W | 01 | NO FAULT | OTHER | 3656R | 01 | EMPIRE BLUE CROSS | OTHER | 000416905003 | 01 | BLUE SHIELD NENY | OTHER | 232129 | 01 | TRICARE NORTH REGION | OTHER | 4126832 | 01 | MVP | OTHER |