MEDICARE: NEIL L. ISDANER, MD. PC

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	207V00000X	Obstetrics & Gynecology Physician	MD017922E	PA

General Provider Information

NPI Number	:	1295097616
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEIL L. ISDANER, MD. PC

Provider Business Mailing Address
First Line	:	7602 CENTRAL AVE
Second Line	:	STAPLEY BLDG ST 103
City	:	PHILA
State	:	PA
Zip	:	19111-2443
Country	:	US
Telephone Number	:	215-745-7411
Fax Number	:	215-745-7288

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

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEIL LEWIS ISDANER
Credential	:	MD
Telephone Number	:	215-745-7411

Provider Enumeration Date	:	06/12/2012
Last Update Date	:	06/12/2012

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