Provider Demographics
NPI:1780655951
Name:ZACHARIAH, CHEMANOOR U (MD)
Entity Type:Individual
Prefix:MR
First Name:CHEMANOOR
Middle Name:U
Last Name:ZACHARIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:130 W 11TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3935
Mailing Address - Country:US
Mailing Address - Phone:209-833-0886
Mailing Address - Fax:209-835-6614
Practice Address - Street 1:130 W 11TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3935
Practice Address - Country:US
Practice Address - Phone:209-833-0886
Practice Address - Fax:209-835-6614
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2016-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA30629207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A306291Medicaid
CA00A306290Medicare PIN
D37939Medicare UPIN