Provider Demographics
NPI:1942252507
Name:SOSNOVSKY, ISABELLA (MD)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:SOSNOVSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8220 CASTOR AVE
Mailing Address - Street 2:
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2729
Mailing Address - Country:US
Mailing Address - Phone:215-728-4550
Mailing Address - Fax:215-728-4559
Practice Address - Street 1:8220 CASTOR AVE
Practice Address - Street 2:
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19152-2729
Practice Address - Country:US
Practice Address - Phone:215-728-4550
Practice Address - Fax:215-728-4559
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062626L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD062626LOtherLICENSE NUMBER
PA0017096800001Medicaid
PAMD062626LOtherLICENSE NUMBER
PASO0020531Medicare ID - Type Unspecified