Healthcare Provider Details

I. General information

NPI: 1831301308
Provider Name (Legal Business Name): MARIA ADELAIDA GIRALDO-ISAZA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 05/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 OLD YORK RD LIFTER 1ST FLOOR, RM. 1615
PHILADELPHIA PA
19141-3018
US

IV. Provider business mailing address

PO BOX 8500-8735
PHILADELPHIA PA
19178-8735
US

V. Phone/Fax

Practice location:
  • Phone: 215-456-8261
  • Fax:
Mailing address:
  • Phone: 215-456-7000
  • Fax: 215-254-3289

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD 436988
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207VC0200X
TaxonomyCritical Care Medicine (Obstetrics & Gynecology) Physician
License NumberMD 436988
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: