Provider Demographics
NPI:1396785598
Name:ISAACS, MARK NEAL (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:NEAL
Last Name:ISAACS
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 1:630 THOMAS L BERKLEY WAY
Mailing Address - Street 2:APT 508
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1865
Mailing Address - Country:US
Mailing Address - Phone:510-569-1310
Mailing Address - Fax:
Practice Address - Street 1:1981 N BROADWAY STE 270
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-3886
Practice Address - Country:US
Practice Address - Phone:925-932-6442
Practice Address - Fax:925-932-6260
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2023-01-25
Deactivation Date:2023-01-04
Deactivation Code:
Reactivation Date:2023-01-09
Provider Licenses
StateLicense IDTaxonomies
CAG32292207Q00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A45089Medicare UPIN
CA00G322920Medicare ID - Type Unspecified