Provider Demographics
NPI:1568443869
Name:ISAAC, PETER J (DO)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:ISAAC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 N CEDAR CREST BLVD STE 110B
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2351
Mailing Address - Country:US
Mailing Address - Phone:610-973-1410
Mailing Address - Fax:610-973-1449
Practice Address - Street 1:1275 S CEDAR CREST BLVD STE 2
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6207
Practice Address - Country:US
Practice Address - Phone:610-820-5703
Practice Address - Fax:610-433-5660
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS005861L2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1538907OtherGATEWAY HEALTH PLAN
PA0012579850008Medicaid
153138OtherUNISON
50036423OtherCBC
653413OtherHIGHMARK BLUE SHIELD
20033449OtherAMERIHEALTH MERCY
0484998000OtherIBC
P00138845OtherRR MEDICARE
1538907OtherGATEWAY HEALTH PLAN
PA0012579850004Medicaid
PA653413S32Medicare PIN