1689666745 NPI number — DR. PETER T ZACHARIA MD

Table of content: DR. PETER T ZACHARIA MD (NPI 1689666745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689666745 NPI number — DR. PETER T ZACHARIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZACHARIA
Provider First Name:
PETER
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689666745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 LANCASTER ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01609-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-791-8484
Provider Business Mailing Address Fax Number:
508-791-1658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
33 LANCASTER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WORCESTER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01609-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-791-8484
Provider Business Practice Location Address Fax Number:
508-791-1658
Provider Enumeration Date:
08/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  75948 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 075948 . This is a "TUFTS ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3101568 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44372 . This is a "FALLONID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 997577 . This is a "NETWORK HEALTH ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 489370 . This is a "CIGNA ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 151563 . This is a "HARVARD PILGIM HP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 753183220 . This is a "GROUP TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J13064 . This is a "BLUE SHIELD ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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