1851838502 NPI number — CHAD ZATEZALO MD LLC

Table of content: (NPI 1851838502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851838502 NPI number — CHAD ZATEZALO MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHAD ZATEZALO MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1851838502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8401 CONNECTICUT AVE STE 640
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHEVY CHASE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20815-9904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
917-664-2585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 CONNECTICUT AVE STE 640
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CHEVY CHASE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20815-5839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-304-6600
Provider Business Practice Location Address Fax Number:
301-304-6601
Provider Enumeration Date:
01/19/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ZATEZALO
Authorized Official First Name:
CHAD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
917-664-2585

Provider Taxonomy Codes

  • Taxonomy code: 207WX0200X , with the licence number:  D0074823 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0019 . This is a "BSD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3196655 . This is a "UHCMAM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 0019 . This is a "CAPCHO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 3196655 . This is a "UHC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4014787 . This is a "FOR" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P4756972 . This is a "OXFORD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4014787 . This is a "MAI" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 1377094 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 977656-01 . This is a "BSM" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PO1109268 . This is a "RME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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