Provider Demographics
NPI:1952310302
Name:ZOUZAS, TANYA (DO)
Entity Type:Individual
Prefix:
First Name:TANYA
Middle Name:
Last Name:ZOUZAS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 CHELMSFORD ST
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824
Mailing Address - Country:US
Mailing Address - Phone:978-250-0032
Mailing Address - Fax:978-256-1348
Practice Address - Street 1:227 CHELMSFORD ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824
Practice Address - Country:US
Practice Address - Phone:978-250-0032
Practice Address - Fax:978-256-1348
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA208471207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA208471OtherTUFTS
MAJ24286OtherBLUE CROSS
MA9758488Medicaid
MAJ24286OtherBLUE CROSS
MA208471OtherTUFTS
MA9758488Medicaid