Provider Demographics
NPI:1225035348
Name:ISAAC, MOHSEN A (MD)
Entity Type:Individual
Prefix:
First Name:MOHSEN
Middle Name:A
Last Name:ISAAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1163 COUNTRY CLUB RD
Mailing Address - Street 2:MELENYZER PAVILION
Mailing Address - City:MONONGAHELA
Mailing Address - State:PA
Mailing Address - Zip Code:15063-1013
Mailing Address - Country:US
Mailing Address - Phone:724-258-1970
Mailing Address - Fax:724-258-1784
Practice Address - Street 1:1163 COUNTRY CLUB RD
Practice Address - Street 2:MELENYZER PAVILION
Practice Address - City:MONONGAHELA
Practice Address - State:PA
Practice Address - Zip Code:15063-1013
Practice Address - Country:US
Practice Address - Phone:724-258-1970
Practice Address - Fax:724-258-1784
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD04191232085R0001X
PAMD4191232085R0202X, 2085R0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH73576Medicare UPIN