Provider Demographics
NPI:1609934694
Name:ZICHERMAN, JASON M (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:M
Last Name:ZICHERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JASON
Other - Middle Name:M
Other - Last Name:ZICHERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1255 S CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 3600
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6256
Mailing Address - Country:US
Mailing Address - Phone:610-770-1606
Mailing Address - Fax:610-740-0560
Practice Address - Street 1:1255 S CEDAR CREST BLVD
Practice Address - Street 2:SUITE 3600
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6256
Practice Address - Country:US
Practice Address - Phone:610-770-1606
Practice Address - Fax:610-740-0560
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA074917002085N0700X, 2085R0202X
VA01012410682085R0202X
PAMD4338822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3995 0099OtherCAREFIRST
DCP00425143OtherMEDICARE PIN
PA1010988900003Medicaid
VAP00429961OtherMEDICARE PIN
WV3810008997Medicaid
170571Medicare UPIN
DCP00425143OtherMEDICARE PIN
I70571Medicare UPIN
DC021229F43Medicare PIN