Provider Demographics
NPI:1891703831
Name:ZIARI, FATANEH M
Entity Type:Individual
Prefix:MRS
First Name:FATANEH
Middle Name:M
Last Name:ZIARI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 GLASGOW AVENUE
Mailing Address - Street 2:SUITE 214
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702
Mailing Address - Country:US
Mailing Address - Phone:302-836-8533
Mailing Address - Fax:302-836-5159
Practice Address - Street 1:2600 GLASGOW AVENUE
Practice Address - Street 2:SUITE 214
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702
Practice Address - Country:US
Practice Address - Phone:302-836-8533
Practice Address - Fax:302-836-5159
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10004255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001116001Medicaid
P10160Medicare UPIN