Provider Demographics
NPI:1508137977
Name:ZACHARIAH, JIPS JOHN (MD)
Entity Type:Individual
Prefix:
First Name:JIPS
Middle Name:JOHN
Last Name:ZACHARIAH
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:PO BOX 1845
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28687-1845
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:633 BROOKDALE DR STE 100
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3471
Practice Address - Country:US
Practice Address - Phone:704-873-7850
Practice Address - Fax:704-838-1544
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101252435207R00000X
NY266398207R00000X, 207RC0000X
NC2017-01310207RC0000X
NC201701310207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease