Healthcare Provider Details

I. General information

NPI: 1518096577
Provider Name (Legal Business Name): ROSS BARRY ISAACS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 AVON ST STE 9
CHARLOTTESVILLE VA
22902-5750
US

IV. Provider business mailing address

310 AVON ST STE 9
CHARLOTTESVILLE VA
22902-5750
US

V. Phone/Fax

Practice location:
  • Phone: 434-581-3271
  • Fax: 434-581-1105
Mailing address:
  • Phone: 434-581-3271
  • Fax: 434-581-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101050154
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101050154
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: