Healthcare Provider Details

I. General information

NPI: 1225026289
Provider Name (Legal Business Name): DENNIS A ISENHOWER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/26/2025
Certification Date: 12/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2604 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9417
US

IV. Provider business mailing address

2604 MEDICAL OFFICE PL
GOLDSBORO NC
27534-9417
US

V. Phone/Fax

Practice location:
  • Phone: 919-580-0004
  • Fax: 919-580-9099
Mailing address:
  • Phone: 919-580-0004
  • Fax: 919-580-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number104091
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: