Provider Demographics
NPI:1699354639
Name:ISAACSON, GRACE (DO)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:ISAACSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-375-6560
Mailing Address - Fax:814-375-2848
Practice Address - Street 1:145 HOSPITAL AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-1462
Practice Address - Country:US
Practice Address - Phone:814-371-2200
Practice Address - Fax:814-372-2573
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT021236390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program