Basic Information
Provider Information | |||||||||
NPI: | 1568443869 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ISAAC | ||||||||
FirstName: | PETER | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1605 N CEDAR CREST BLVD STE 110B | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181042351 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6109731410 | ||||||||
FaxNumber: | 6109731449 | ||||||||
Practice Location | |||||||||
Address1: | 1275 S CEDAR CREST BLVD STE 2 | ||||||||
Address2: |   | ||||||||
City: | ALLENTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 181036207 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6108205703 | ||||||||
FaxNumber: | 6104335660 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 11/14/2005 | ||||||||
LastUpdateDate: | 07/02/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 07/02/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | OS005861L | PA | Y |   | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
ID Information
ID | Type | State | Issuer | Description | 0012579850004 | 05 | PA |   | MEDICAID | 50036423 | 01 |   | CBC | OTHER | 153138 | 01 |   | UNISON | OTHER | 653413 | 01 |   | HIGHMARK BLUE SHIELD | OTHER | 0484998000 | 01 |   | IBC | OTHER | 1538907 | 01 |   | GATEWAY HEALTH PLAN | OTHER | 20033449 | 01 |   | AMERIHEALTH MERCY | OTHER | P00138845 | 01 |   | RR MEDICARE | OTHER |