Provider Demographics
NPI:1063472462
Name:ZALDIVAR, MARIE LUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LUISE
Last Name:ZALDIVAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:208 BLACK FOREST DR
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-5314
Mailing Address - Country:US
Mailing Address - Phone:919-550-0520
Mailing Address - Fax:919-550-0520
Practice Address - Street 1:127 E MARKET ST
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-3915
Practice Address - Country:US
Practice Address - Phone:919-934-7687
Practice Address - Fax:919-934-5297
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2021-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NC9801124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC11623OtherBCBS OF NC
NC8911623Medicaid
NC11623OtherBCBS OF NC
NCF99912Medicare UPIN