Provider Demographics
NPI:1114910775
Name:ZACHARIAH, DAISY SARAMA (MD)
Entity Type:Individual
Prefix:MS
First Name:DAISY
Middle Name:SARAMA
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:DAISY
Other - Middle Name:SARAMA
Other - Last Name:PURACAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6105 PANORAMA DR NE
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98422
Mailing Address - Country:US
Mailing Address - Phone:253-952-6917
Mailing Address - Fax:253-476-1437
Practice Address - Street 1:6105 PANORAMA DR NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422
Practice Address - Country:US
Practice Address - Phone:253-952-6917
Practice Address - Fax:253-476-1437
Is Sole Proprietor?:No
Enumeration Date:2005-08-29
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00017284173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA018728OtherL&I
WA1122985Medicaid
001000964Medicare PIN
WA1122985Medicaid