Provider Demographics
NPI:1992856033
Name:ZAPATA, MARIO GUILLERMO (MD)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:GUILLERMO
Last Name:ZAPATA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 BROOKDALE DR
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-4107
Mailing Address - Country:US
Mailing Address - Phone:704-883-8660
Mailing Address - Fax:704-883-8661
Practice Address - Street 1:515 BROOKDALE DR
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-4107
Practice Address - Country:US
Practice Address - Phone:704-883-8660
Practice Address - Fax:704-883-8661
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2002000862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5900106Medicaid
NCH24249Medicare UPIN
NC2297819AMedicare PIN