Provider Demographics
NPI:1073262341
Name:SMITH, ZACHARY JAY (MD, MBA)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:JAY
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:376 W 10TH AVE
Mailing Address - Street 2:774 PRIOR HALL
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210
Mailing Address - Country:US
Mailing Address - Phone:740-404-9802
Mailing Address - Fax:
Practice Address - Street 1:376 W 10TH AVE
Practice Address - Street 2:774 PRIOR HALL
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-293-3570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program