Provider Demographics
NPI:1558345777
Name:ZAGORIA, RONALD JAY (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAY
Last Name:ZAGORIA
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 1:1364 CLIFTON RD NE # D112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1059
Mailing Address - Country:US
Mailing Address - Phone:404-778-3800
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE # D112
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-2204
Practice Address - Country:US
Practice Address - Phone:404-778-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG893862085R0204X
NC283912085R0204X, 2085U0001X
GA907282085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC64196OtherMEDCOST
SCQ28392Medicaid
NC4477989OtherAETNA
NC7989892Medicaid
NC5170OtherPARTNERS
NC89892OtherBCBS
WV198526000Medicaid
VA7230192Medicaid
NC5170OtherPARTNERS
NC4477989OtherAETNA
VA7230192Medicaid