Provider Demographics
NPI:1417111014
Name:ISSAC, VERONICA ELISABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:ELISABETH
Last Name:ISSAC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 EUCLID AVE # R3
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-0001
Mailing Address - Country:US
Mailing Address - Phone:216-444-3566
Mailing Address - Fax:216-445-3523
Practice Address - Street 1:9500 EUCLID AVE # R3
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-0001
Practice Address - Country:US
Practice Address - Phone:216-444-3566
Practice Address - Fax:216-444-3566
Is Sole Proprietor?:No
Enumeration Date:2008-07-12
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1270442080A0000X, 2080A0000X
PAMD442417208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics