Provider Demographics
NPI:1730134099
Name:ISAAC, JAY J (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:J
Last Name:ISAAC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BLACKBURN DR
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-2237
Mailing Address - Country:US
Mailing Address - Phone:978-282-3698
Mailing Address - Fax:978-282-3612
Practice Address - Street 1:1 BLACKBURN DR
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-2237
Practice Address - Country:US
Practice Address - Phone:978-281-1500
Practice Address - Fax:978-282-3699
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA160031207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3195601Medicaid
A29492Medicare PIN
MA3195601Medicaid