Healthcare Provider Details

I. General information

NPI: 1043994700
Provider Name (Legal Business Name): MEGHAN ELIZABETH IZAK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 S COUNTY LINE RD
SOUDERTON PA
18964-2814
US

IV. Provider business mailing address

4 S COUNTY LINE RD
SOUDERTON PA
18964-2814
US

V. Phone/Fax

Practice location:
  • Phone: 215-723-7177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOT022470
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS025815
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: