MEDICARE: DR. NEIL L ISDANER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	MD017922E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47074	OTHER	PA	KEYSTONE MERCY
2	05971	OTHER	PA	USHC
3	0052872000	OTHER	PA	KEYSTONE/PERSONAL CHOICE

General Provider Information

NPI Number	:	1093783409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEIL L ISDANER M.D.

Provider Business Mailing Address
First Line	:	7602 CENTRAL AVE
Second Line	:	SUITE 103
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-745-7411
Fax Number	:	215-745-7488

Provider Business Practice Location Address
First Line	:	7602 CENTRAL AVE
Second Line	:	SUITE 103
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-745-7411
Fax Number	:	215-745-7488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	03/03/2017

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Directions to “ DR. NEIL L ISDANER M.D.” Practice Location

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