Provider Demographics
NPI:1437309648
Name:VICKERY, ZEVIDAH (MD)
Entity Type:Individual
Prefix:DR
First Name:ZEVIDAH
Middle Name:
Last Name:VICKERY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ZEVIDAH
Other - Middle Name:
Other - Last Name:REISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 METROHEALTH DR
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44109-1900
Mailing Address - Country:US
Mailing Address - Phone:646-301-9964
Mailing Address - Fax:662-214-9732
Practice Address - Street 1:2500 METROHEALTH DR
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44109-1900
Practice Address - Country:US
Practice Address - Phone:216-778-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-24
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA252675207V00000X
NY278831207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110093365/AMedicaid
MA002935301Medicare PIN