Provider Demographics
NPI:1003828435
Name:ZACK, CATHY J (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:J
Last Name:ZACK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4 FARM SPRINGS RD
Mailing Address - Street 2:PROHEALTH PHYSICIANS
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2573
Mailing Address - Country:US
Mailing Address - Phone:860-284-5200
Mailing Address - Fax:860-284-5333
Practice Address - Street 1:120 MAIN ST
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:CT
Practice Address - Zip Code:06424-1123
Practice Address - Country:US
Practice Address - Phone:860-267-2593
Practice Address - Fax:860-267-4889
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2017-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT030910207Q00000X
CT30910208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTF15983Medicare UPIN