Provider Demographics
NPI:1720077563
Name:ZANG, KATHERINE HEISS (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:HEISS
Last Name:ZANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:DEMER
Other - Last Name:HEISS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 HO PLAZA
Mailing Address - Street 2:GANNETT HEALTH SERVICES
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14853
Mailing Address - Country:US
Mailing Address - Phone:607-255-6106
Mailing Address - Fax:607-254-3503
Practice Address - Street 1:110 HO PLAZA
Practice Address - Street 2:GANNETT HEALTH SERVICES
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14853
Practice Address - Country:US
Practice Address - Phone:607-255-6106
Practice Address - Fax:607-254-3503
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20050193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21183759Medicaid
CO88559068Medicaid
AZ945587Medicaid
8HD903Medicare PIN
AZ945587Medicaid
320059Medicare Oscar/Certification