Provider Demographics
NPI:1801852934
Name:ZAKKO, SALAM F (MD)
Entity Type:Individual
Prefix:
First Name:SALAM
Middle Name:F
Last Name:ZAKKO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 WATERCHASE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-2110
Mailing Address - Country:US
Mailing Address - Phone:602-574-1318
Mailing Address - Fax:860-257-4519
Practice Address - Street 1:25 NEWELL RD
Practice Address - Street 2:SUITE E-36
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5100
Practice Address - Country:US
Practice Address - Phone:860-583-9252
Practice Address - Fax:860-585-9848
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO024498207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001244987Medicaid
100000396Medicare ID - Type Unspecified
CT001244987Medicaid