Provider Demographics
NPI:1821133489
Name:ZACHARY, JOHN STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:ZACHARY
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 1:1521 HUGUENOT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-2426
Mailing Address - Country:US
Mailing Address - Phone:804-794-1072
Mailing Address - Fax:804-794-5137
Practice Address - Street 1:1521 HUGUENOT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-2426
Practice Address - Country:US
Practice Address - Phone:804-794-1072
Practice Address - Fax:804-794-5137
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010352262080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA082365OtherANTHEM PROVIDER NUMBER
VA10012163OtherOPTIMA PROVIDER #
VA818403OtherMAMSI ALLIANCE PROV #
VA0000058166201OtherUNITED HEALTHCARE PROV#
VA276098OtherSOUTHERN HEALTH PROV #
VA677345OtherAETNA PROVIDER NUMBER
VA0753949OtherCIGNA PROVIDER #
VA677345OtherAETNA PROVIDER NUMBER