Provider Demographics
NPI:1033173257
Name:ZACCHEO, MATTHEW V (DO)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:V
Last Name:ZACCHEO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S FRONT ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17101-2010
Mailing Address - Country:US
Mailing Address - Phone:717-231-8772
Mailing Address - Fax:717-231-8435
Practice Address - Street 1:111 S FRONT ST
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17101-2010
Practice Address - Country:US
Practice Address - Phone:717-231-8772
Practice Address - Fax:717-231-8435
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012450207R00000X, 207RC0200X
MI5101018545207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1033173267Medicaid
WV1071104OtherW. VIRGINIA WORKERS COMP
PA1010579960002Medicaid
PA197616OtherUNISON
PAP00380522OtherRR MEDICARE
MI1417961137OtherBCBSM - BMH TAX ID
PA1427756OtherAETNA
PA410337OtherUPMC
NY00027186402OtherUNIVERA
PA1540527OtherGATEWAY
OH2702892OtherOH MEDICAID
NY02833796OtherNY MEDICAID
MI1417961137OtherBCBSM - BMH
MI1255304358Medicaid
PA1633761OtherBLUE SHIELD
PA1427756OtherAETNA
PA197616OtherUNISON
WV1071104OtherW. VIRGINIA WORKERS COMP