Provider Demographics
NPI:1841580792
Name:ISAAC, ELIZABETH (MAC; LAC; ADS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:ISAAC
Suffix:
Gender:F
Credentials:MAC; LAC; ADS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7812 EMILYS WAY
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2465
Mailing Address - Country:US
Mailing Address - Phone:301-474-6753
Mailing Address - Fax:443-552-0319
Practice Address - Street 1:715 PARK AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4711
Practice Address - Country:US
Practice Address - Phone:410-454-0178
Practice Address - Fax:443-552-0319
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-12
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01451171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist