Provider Demographics
NPI:1265412944
Name:ISADA, LORETTA R (MD)
Entity type:Individual
Prefix:
First Name:LORETTA
Middle Name:R
Last Name:ISADA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LORETTA
Other - Middle Name:B
Other - Last Name:ROACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4125 MEDINA RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2483
Mailing Address - Country:US
Mailing Address - Phone:330-665-8222
Mailing Address - Fax:330-666-2599
Practice Address - Street 1:4125 MEDINA RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2483
Practice Address - Country:US
Practice Address - Phone:330-665-8222
Practice Address - Fax:330-666-2599
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-057341207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0884815Medicaid
OH1841239274OtherMEDICARE GROUP NPI #
OH2551671OtherPPG MEDICAID GROUP #
OH9338635OtherMEDICARE GROUP NUMBER
OH4122513Medicare PIN
OH9338635OtherMEDICARE GROUP NUMBER