Provider Demographics
NPI:1689666745
Name:ZACHARIA, PETER T (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:ZACHARIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-2615
Mailing Address - Country:US
Mailing Address - Phone:508-791-8484
Mailing Address - Fax:508-791-1658
Practice Address - Street 1:33 LANCASTER ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-2615
Practice Address - Country:US
Practice Address - Phone:508-791-8484
Practice Address - Fax:508-791-1658
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75948207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA075948OtherTUFTS ID
MA3101568Medicaid
MA44372OtherFALLONID
MA997577OtherNETWORK HEALTH ID
MA489370OtherCIGNA ID
MA151563OtherHARVARD PILGIM HP
MA753183220OtherGROUP TAX ID
MAJ13064OtherBLUE SHIELD ID
MA489370OtherCIGNA ID
MA753183220OtherGROUP TAX ID