Provider Demographics
NPI:1730143629
Name:ZAZZARO, PATRICK F (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:F
Last Name:ZAZZARO
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:PO BOX 1067
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-1067
Mailing Address - Country:US
Mailing Address - Phone:703-361-3030
Mailing Address - Fax:703-361-2687
Practice Address - Street 1:8700 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4418
Practice Address - Country:US
Practice Address - Phone:703-369-8341
Practice Address - Fax:703-369-8423
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010291092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7237375Medicaid
VA7237367Medicaid
VA7237316Medicaid
VA7247362Medicaid
VA6688-0009OtherCAREFIRST
VA7230354Medicaid
VA300000709Medicare ID - Type Unspecified
VA7237316Medicaid