Provider Demographics
NPI:1417981275
Name:ZACHARIA, LAURENCE ALAN (MD)
Entity Type:Individual
Prefix:
First Name:LAURENCE
Middle Name:ALAN
Last Name:ZACHARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7823 WAKELEY PLAZA
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68114-3651
Mailing Address - Country:US
Mailing Address - Phone:402-393-7550
Mailing Address - Fax:402-393-1017
Practice Address - Street 1:7823 WAKELEY PLAZA
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68114-3651
Practice Address - Country:US
Practice Address - Phone:402-393-7550
Practice Address - Fax:402-393-1017
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11414207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0581629Medicaid
NE1022OtherBCBS
NE1022OtherBCBS
IA0581629Medicaid