Provider Demographics
NPI:1760460828
Name:ISAAC, ZACHARIA (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARIA
Middle Name:
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 1:10 HOOSIC DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1226
Mailing Address - Country:US
Mailing Address - Phone:781-575-0573
Mailing Address - Fax:
Practice Address - Street 1:125 NASHUA ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-1101
Practice Address - Country:US
Practice Address - Phone:617-573-2188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-08
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA214568207R00000X, 208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
80621OtherHARVARD PILGRIM
MA0173991Medicaid
214568OtherTUFTS
J25317OtherBLUE CROSS
J25317OtherBLUE CROSS
A34157Medicare ID - Type Unspecified