Provider Demographics
NPI:1508817495
Name:ZARYCHTA, WILLIAM ALEX (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALEX
Last Name:ZARYCHTA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 2ND ST SW
Mailing Address - Street 2:USCG HQ HSC(K), RM B732
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-372-4100
Mailing Address - Fax:202-372-4912
Practice Address - Street 1:USCG HQ CLINIC HSC(K)
Practice Address - Street 2:2100 SECOND STREET SW, RMB732
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:202-372-4100
Practice Address - Fax:202-372-4912
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA050780363A00000X
PAOA000713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P49843Medicare UPIN
PA058594Medicare ID - Type Unspecified