Individual
REBECCA ISSERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
3401 CIVIC CENTER BLVD, SUITE 9329, PHILADELPHIA, PA 19104-4319
(215) 590-1858
(215) 590-1415
Mailing address
3401 CIVIC CENTER BLVD STE 9329, PHILADELPHIA, PA 19104-4319
(267) 425-9300
(267) 425-9331
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
MD451472
PA
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD451472
PA
208000000X
Pediatrics Physician
MT197598
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1030697530001
—
PA
01
—
429963EJL
MEDICARE PTAN
PA
Enumeration date
07/02/2010
Last updated
06/02/2023
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