Provider Demographics
NPI:1609855683
Name:ZACHARIAH, MOLLY ANN (MD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANN
Last Name:ZACHARIAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 NW 49TH ST STE 125
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3750
Mailing Address - Country:US
Mailing Address - Phone:954-958-5200
Mailing Address - Fax:954-473-7686
Practice Address - Street 1:6405 N FEDERAL HWY STE 300
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1414
Practice Address - Country:US
Practice Address - Phone:954-958-5200
Practice Address - Fax:954-958-5105
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41760207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277303100Medicaid
FL277303100Medicaid
FL94467ZMedicare PIN