Provider Demographics
NPI:1457376717
Name:ZACHARIAH, BENOY J (MD)
Entity Type:Individual
Prefix:
First Name:BENOY
Middle Name:J
Last Name:ZACHARIAH
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 1:830 OAK ST
Mailing Address - Street 2:SUITE 205W
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301
Mailing Address - Country:US
Mailing Address - Phone:508-583-4440
Mailing Address - Fax:508-583-7401
Practice Address - Street 1:830 OAK ST
Practice Address - Street 2:SUITE 205W
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-583-4440
Practice Address - Fax:508-583-7401
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA156141207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0163830Medicaid
MAA28739Medicare ID - Type UnspecifiedINDIVIDUAL
MA0163830Medicaid