Provider Demographics
NPI:1942270269
Name:ZACHARY, KIMON C (MD)
Entity Type:Individual
Prefix:DR
First Name:KIMON
Middle Name:C
Last Name:ZACHARY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-3906
Mailing Address - Fax:617-726-7653
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:MASSACHUSETTS GENERAL HOSPITAL
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2622
Practice Address - Country:US
Practice Address - Phone:617-726-3906
Practice Address - Fax:617-726-7653
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-08-27
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Provider Licenses
StateLicense IDTaxonomies
MA150761207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3177262Medicaid
MA150761OtherTUFTS HEALTH PLAN
MAJ18208OtherBCBS MA
G65852Medicare UPIN
MA3177262Medicaid