Provider Demographics
NPI:1083653224
Name:ZUCKERMAN, MARCIA L (MD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:L
Last Name:ZUCKERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 CHESTNUT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-3453
Mailing Address - Country:US
Mailing Address - Phone:617-242-2082
Mailing Address - Fax:
Practice Address - Street 1:227 BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6773
Practice Address - Country:US
Practice Address - Phone:617-731-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2103062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
A34406Medicare ID - Type Unspecified
MAH67032Medicare UPIN