Provider Demographics
NPI:1952322810
Name:JEANNE ISAACSON, M.D., PC
Entity Type:Organization
Organization Name:JEANNE ISAACSON, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-246-8000
Mailing Address - Street 1:14463 MILITARY RD S
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-4255
Mailing Address - Country:US
Mailing Address - Phone:206-246-8000
Mailing Address - Fax:206-243-6996
Practice Address - Street 1:14463 MILITARY RD S
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-4255
Practice Address - Country:US
Practice Address - Phone:206-246-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1115880Medicaid
WA110237888OtherRR MEDICARE
WA1224ISOtherREGENCE
WA1224ISOtherREGENCE
WA1115880Medicaid