Provider Demographics
NPI:1316023146
Name:ZICHITTELLA, ZACHRY PETER (MD)
Entity Type:Individual
Prefix:
First Name:ZACHRY
Middle Name:PETER
Last Name:ZICHITTELLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:280 CHESTNUT ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01199-1001
Mailing Address - Country:US
Mailing Address - Phone:413-794-5700
Mailing Address - Fax:
Practice Address - Street 1:40 WRIGHT ST
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:MA
Practice Address - Zip Code:01069-1138
Practice Address - Country:US
Practice Address - Phone:413-284-5400
Practice Address - Fax:413-284-5559
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA230816207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1316023146OtherBMCHP (COMMONWEALTH CARE)
5372192OtherCIGNA/GREAT WEST
002228301OtherMEDICARE PTAN
94085601OtherNETWORK HEALTH PLAN
1316023146OtherUNICARE
230816OtherCONNECTICARE
1316023146OtherFALLON
1316023146OtherNEIGHBORHOOD HEALTH PLAN
1316023146OtherTRICARE
51187OtherHEALTH NEW ENGLAND
9001663OtherAETNA
MAJ48300OtherBCBS
S012207OtherCHAMPUS
1316023146OtherUNITED HEALTH CARE
AA201435OtherHARVARD PILGRIM HEALTH CARE