Provider Demographics
NPI:1275523599
Name:ZACOUR, TODD A (DO)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:A
Last Name:ZACOUR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 MASSILLON RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:UNIONTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44685-6400
Mailing Address - Country:US
Mailing Address - Phone:330-899-9350
Mailing Address - Fax:330-634-1329
Practice Address - Street 1:4880 S MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-4474
Practice Address - Country:US
Practice Address - Phone:330-644-2700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2016-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004146Z207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0740621Medicaid
OH0740621Medicaid
OHZA0653877Medicare PIN