Healthcare Provider Details

I. General information

NPI: 1225035348
Provider Name (Legal Business Name): MOHSEN A ISAAC MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1163 COUNTRY CLUB RD MELENYZER PAVILION
MONONGAHELA PA
15063-1013
US

IV. Provider business mailing address

1163 COUNTRY CLUB RD MELENYZER PAVILION
MONONGAHELA PA
15063-1013
US

V. Phone/Fax

Practice location:
  • Phone: 724-258-1970
  • Fax: 724-258-1784
Mailing address:
  • Phone: 724-258-1970
  • Fax: 724-258-1784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD0419123
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD419123
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberMD419123
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: