Basic Information
| Provider Information | |||||||||
| NPI: | 1750744793 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ISMAILOV | ||||||||
| FirstName: | IGOR | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829641 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673705296 | ||||||||
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| Practice Location | |||||||||
| Address1: | 595 W STATE ST | ||||||||
| Address2: | |||||||||
| City: | DOYLESTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 189012554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153452885 | ||||||||
| FaxNumber: | 2153452552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2016 | ||||||||
| LastUpdateDate: | 04/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | ME137724 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | MD469390 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.