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General NPI Number Information
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NPI Number | 1104844133
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Entity Type | Individual
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Provider Name | AYODELE T ISAACS MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 163 VAN BUREN RD
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City | CARIBOU
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State | ME
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Zip | 04736-3567
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Country | US
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Telephone | 207-498-3111
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Fax | 207-496-2631
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Provider Business Mailing Address
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Address Line | 13 CRONIN RD
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City | PRESQUE ISLE
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State | ME
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Zip | 04769-5289
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Country | US
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Telephone | 207-764-3457
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD15922
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License Number State | ME
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