Provider Demographics
NPI:1043472400
Name:HADJIZACHARIA, PANTELIS (MD)
Entity Type:Individual
Prefix:
First Name:PANTELIS
Middle Name:
Last Name:HADJIZACHARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 560825
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80256-0825
Mailing Address - Country:US
Mailing Address - Phone:719-595-7580
Mailing Address - Fax:719-595-7417
Practice Address - Street 1:1600 N. GRAND AVE.
Practice Address - Street 2:SUITE 500
Practice Address - City:PURBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2757
Practice Address - Country:US
Practice Address - Phone:719-545-0663
Practice Address - Fax:719-595-7903
Is Sole Proprietor?:No
Enumeration Date:2008-06-26
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0054955207RC0000X
AZR70524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76507254Medicaid