Healthcare Provider Details

I. General information

NPI: 1073190377
Provider Name (Legal Business Name): ISAAC DAUDELIN MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 CHESTNUT ST FL 11
PHILADELPHIA PA
19107-3612
US

IV. Provider business mailing address

1101 MARKET ST STE 2700
PHILADELPHIA PA
19107-2927
US

V. Phone/Fax

Practice location:
  • Phone: 215-955-7785
  • Fax:
Mailing address:
  • Phone: 215-955-7785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberMD494790
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: