Provider Demographics
NPI:1457640864
Name:ISA HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:ISA HEALTH SYSTEMS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWTAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-990-1811
Mailing Address - Street 1:420 CHINQUAPIN ROUND RD
Mailing Address - Street 2:I-2
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4006
Mailing Address - Country:US
Mailing Address - Phone:410-990-1811
Mailing Address - Fax:410-990-0081
Practice Address - Street 1:8965 GUILFORD RD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2384
Practice Address - Country:US
Practice Address - Phone:410-290-8800
Practice Address - Fax:410-290-8870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00584832084P0800X, 2084P0804X
2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Single Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403435002Medicaid