Glenn C Isaacson, MD

Primary specialty

Otolaryngology PhysicianTaxonomy code 207Y00000X

License

MD030568E Issued in PA

Practice address

3509 N Broad St
Philadelphia, PA 19140

Phone

(215) 707-7300

Fax

(215) 707-6417

NPI assigned

Oct 13, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Abington Pediatric Otolaryngology PC

  • Otolaryngology Physician
  • Rydal, PA
  • NPI 1407168321
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526860800000",
    "number": "1104814078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 W HUNTING PARK AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191291302",
            "telephone_number": "215-707-3663",
            "fax_number": "215-707-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3509 N BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19140",
            "telephone_number": "215-707-7300",
            "fax_number": "215-707-6417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ISAACSON",
        "first_name": "GLENN",
        "middle_name": "C",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-13",
        "last_updated": "2018-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "PA",
            "license": "MD030568E",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0011396520001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Theodore Robert Isaacoff, DPM
• Evan Jonah Isaacs, DO
• Marla B Isaacs, PHD
• Stuart N Isaacs, MD
• Brandon Isaacson, MA, NCC, LAC
• Amy A Isabelle, FNP-BC
• Dmitry Alexander Isaev, CRNP
• Aisha-Elizabeth Isah, MS, MPHIL
• Janet Isaiah
• Patricia Isakowitz, MSW, LSW

• Otolaryngology Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Otolaryngology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.