Provider Demographics
NPI:1508822867
Name:ISSELBACHER, KAREN THEO (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:THEO
Last Name:ISSELBACHER
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 1:70 HASTINGS ST
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-5439
Mailing Address - Country:US
Mailing Address - Phone:781-772-8500
Mailing Address - Fax:781-772-8501
Practice Address - Street 1:70 HASTINGS ST
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-5439
Practice Address - Country:US
Practice Address - Phone:781-444-3550
Practice Address - Fax:781-444-3551
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA59434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ09114Medicare PIN