Provider Demographics
NPI:1346571049
Name:FACAROS, ZACHARIA (DPM)
Entity Type:Individual
Prefix:DR
First Name:ZACHARIA
Middle Name:
Last Name:FACAROS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 KENRICH DR
Mailing Address - Street 2:
Mailing Address - City:CORAOPOLIS
Mailing Address - State:PA
Mailing Address - Zip Code:15108-1091
Mailing Address - Country:US
Mailing Address - Phone:412-915-5803
Mailing Address - Fax:
Practice Address - Street 1:4955 STEUBENVILLE PIKE STE 180
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9604
Practice Address - Country:US
Practice Address - Phone:412-838-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-19
Last Update Date:2023-04-25
Deactivation Date:2022-08-18
Deactivation Code:
Reactivation Date:2022-09-21
Provider Licenses
StateLicense IDTaxonomies
VA0103301086213ES0103X
PASC006791213ES0103X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103616547Medicaid
NJ0592498Medicaid