Provider Demographics
NPI:1760453708
Name:MOKO, ZACHARY
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:MOKO
Suffix:
Gender:M
Credentials:
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 32861
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21282-2861
Mailing Address - Country:US
Mailing Address - Phone:410-366-2660
Mailing Address - Fax:410-366-2662
Practice Address - Street 1:4419 FALLS RD STE D
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21211-1298
Practice Address - Country:US
Practice Address - Phone:410-362-3000
Practice Address - Fax:410-366-2662
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0029276174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE15169Medicare UPIN