Provider Demographics
NPI:1609855915
Name:ZALZAL, ANDRE H (MD)
Entity Type:Individual
Prefix:
First Name:ANDRE
Middle Name:H
Last Name:ZALZAL
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 1:1565 N MAIN ST
Mailing Address - Street 2:STE 506
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720
Mailing Address - Country:US
Mailing Address - Phone:508-730-1666
Mailing Address - Fax:508-646-7119
Practice Address - Street 1:1565 N MAIN ST
Practice Address - Street 2:STE 506
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720
Practice Address - Country:US
Practice Address - Phone:508-730-1666
Practice Address - Fax:508-646-7119
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA32576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2023539Medicaid
MAK08248Medicare ID - Type Unspecified
A59627Medicare UPIN