Provider Demographics
NPI:1225037435
Name:ISAAC, JOHN JR (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:ISAAC
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 TOLL GATE RD
Mailing Address - Street 2:STE.200
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-4326
Mailing Address - Country:US
Mailing Address - Phone:401-739-8010
Mailing Address - Fax:401-739-6087
Practice Address - Street 1:390 TOLL GATE RD
Practice Address - Street 2:STE.200
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-4326
Practice Address - Country:US
Practice Address - Phone:401-739-8010
Practice Address - Fax:401-739-6087
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH20154208600000X
VA0101268741208600000X
RIMD075252086S0129X
RIRI7525208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI200881OtherBLUE CHIP PROVIDER ID
RI7000784Medicaid
NH3121659Medicaid
RI29065-0OtherBLUE CROSS PROVIDER ID
RIE30003Medicare UPIN