Provider Demographics
NPI:1275513384
Name:ZACHARIAH P ZACHARIAH MDPA
Entity Type:Organization
Organization Name:ZACHARIAH P ZACHARIAH MDPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ZACHARIAH
Authorized Official - Middle Name:POOZHIKALA
Authorized Official - Last Name:ZACHARIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-772-2200
Mailing Address - Street 1:4725 N FEDERAL HWY
Mailing Address - Street 2:SUITE 501
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-4603
Mailing Address - Country:US
Mailing Address - Phone:954-772-2200
Mailing Address - Fax:954-938-8829
Practice Address - Street 1:4725 N FEDERAL HWY
Practice Address - Street 2:SUITE 501
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4603
Practice Address - Country:US
Practice Address - Phone:954-772-2200
Practice Address - Fax:954-938-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME27175207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCF7537OtherRRMEDICARE
FL277301500Medicaid
FLCF7537OtherRRMEDICARE