Provider Demographics
NPI:1598438210
Name:WASSERMAN, ZACHARY BRIAN (MSN, CRNP, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:ZACHARY
Middle Name:BRIAN
Last Name:WASSERMAN
Suffix:
Gender:M
Credentials:MSN, CRNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W 40TH ST STE 173
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2147
Mailing Address - Country:US
Mailing Address - Phone:443-961-1221
Mailing Address - Fax:443-965-9780
Practice Address - Street 1:711 W 40TH ST STE 173
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-2147
Practice Address - Country:US
Practice Address - Phone:443-961-1221
Practice Address - Fax:443-965-9780
Is Sole Proprietor?:No
Enumeration Date:2021-07-28
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR227875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily