Provider Demographics
NPI:1578939310
Name:ZACHARY F. VERES D.O., LLC
Entity Type:Organization
Organization Name:ZACHARY F. VERES D.O., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:F
Authorized Official - Last Name:VERES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-979-3325
Mailing Address - Street 1:4681 MAHONING AVE NW
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-1418
Mailing Address - Country:US
Mailing Address - Phone:330-847-7778
Mailing Address - Fax:330-847-6695
Practice Address - Street 1:4681 MAHONING AVE NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-1418
Practice Address - Country:US
Practice Address - Phone:330-847-7778
Practice Address - Fax:330-847-6695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-17
Last Update Date:2015-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2607816Medicaid