Provider Demographics
NPI:1023223781
Name:ZACK, BRIAN HARRIS (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:HARRIS
Last Name:ZACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8792
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-8792
Mailing Address - Country:US
Mailing Address - Phone:440-526-6630
Mailing Address - Fax:440-526-1487
Practice Address - Street 1:500 E ROYALTON RD STE 100
Practice Address - Street 2:
Practice Address - City:BROADVIEW HTS
Practice Address - State:OH
Practice Address - Zip Code:44147-2592
Practice Address - Country:US
Practice Address - Phone:440-526-6630
Practice Address - Fax:440-526-1487
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-093589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics