Healthcare Provider Details

I. General information

NPI: 1225037435
Provider Name (Legal Business Name): JOHN ISAAC JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 TOLL GATE RD STE.200
WARWICK RI
02886-4326
US

IV. Provider business mailing address

390 TOLL GATE RD STE.200
WARWICK RI
02886-4326
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-8010
  • Fax: 401-739-6087
Mailing address:
  • Phone: 401-739-8010
  • Fax: 401-739-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD07525
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number20154
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101268741
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberRI7525
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: