Healthcare Provider Details

I. General information

NPI: 1104844133
Provider Name (Legal Business Name): AYODELE T ISAACS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AYODELE T OLUGBEMI MD

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 VAN BUREN RD
CARIBOU ME
04736-3567
US

IV. Provider business mailing address

13 CRONIN RD
PRESQUE ISLE ME
04769-5289
US

V. Phone/Fax

Practice location:
  • Phone: 207-498-3111
  • Fax: 207-496-2631
Mailing address:
  • Phone: 207-764-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD15922
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: