Provider Demographics
NPI:1851838502
Name:CHAD ZATEZALO MD LLC
Entity Type:Organization
Organization Name:CHAD ZATEZALO MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ZATEZALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-664-2585
Mailing Address - Street 1:8401 CONNECTICUT AVE STE 640
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-9904
Mailing Address - Country:US
Mailing Address - Phone:917-664-2585
Mailing Address - Fax:
Practice Address - Street 1:8401 CONNECTICUT AVE STE 640
Practice Address - Street 2:
Practice Address - City:NORTH CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5839
Practice Address - Country:US
Practice Address - Phone:301-304-6600
Practice Address - Fax:301-304-6601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-19
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074823207WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0019OtherBSD
MD3196655OtherUHCMAM
MD0019OtherCAPCHO
MD3196655OtherUHC
MD4014787OtherFOR
MDP4756972OtherOXFORD
MD4014787OtherMAI
MD1377094OtherCIGNA
MD977656-01OtherBSM
MDPO1109268OtherRME
MD4014787OtherMAI