Healthcare Provider Details

I. General information

NPI: 1861509135
Provider Name (Legal Business Name): GEORGE ISAJIW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 N LANSDOWNE AVE
LANSDOWNE PA
19050-2205
US

IV. Provider business mailing address

23 N LANSDOWNE AVE
LANSDOWNE PA
19050-2205
US

V. Phone/Fax

Practice location:
  • Phone: 610-626-4397
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311Z00000X
TaxonomyCustodial Care Facility
License NumberMD012611E
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD012611E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: