Provider Demographics
NPI:1306045760
Name:BOSHRA G ZAKHARY MD PC
Entity Type:Organization
Organization Name:BOSHRA G ZAKHARY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BOSHRA
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:ZAKHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-792-9110
Mailing Address - Street 1:PO BOX 1121
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24543-1121
Mailing Address - Country:US
Mailing Address - Phone:434-792-9110
Mailing Address - Fax:434-799-6074
Practice Address - Street 1:505 RISON ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2458
Practice Address - Country:US
Practice Address - Phone:434-792-9110
Practice Address - Fax:434-799-6074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044807207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06687Medicare PIN