Provider Demographics
NPI:1952376865
Name:ALKASOV, ISABELLA U (MD)
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:U
Last Name:ALKASOV
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 1:5848 OLD BETHLEHEM PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-9341
Mailing Address - Country:US
Mailing Address - Phone:610-282-2155
Mailing Address - Fax:610-282-2350
Practice Address - Street 1:5848 OLD BETHLEHEM PIKE
Practice Address - Street 2:SUITE # 101
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-9341
Practice Address - Country:US
Practice Address - Phone:610-282-2155
Practice Address - Fax:610-282-2350
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD419824207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019241960003Medicaid
PAH71878Medicare UPIN
PA063290Medicare ID - Type UnspecifiedMEDICARE