Provider Demographics
NPI:1538137674
Name:ZECHER, DEREK R (PA)
Entity Type:Individual
Prefix:
First Name:DEREK
Middle Name:R
Last Name:ZECHER
Suffix:
Gender:M
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:PO BOX 820956
Mailing Address - Street 2:TEMPLE PHYSICIANS INC
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0956
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:100 E LEHIGH AVENUE
Practice Address - Street 2:TEMPLE HOSPITAL EPISCOPAL CAMPUS
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19125
Practice Address - Country:US
Practice Address - Phone:215-707-1656
Practice Address - Fax:215-707-0805
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2017-11-16
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Provider Licenses
StateLicense IDTaxonomies
PAMA050705363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA077008Medicare ID - Type Unspecified
P59787Medicare UPIN