Provider Demographics
NPI:1720288517
Name:ZACHERL, KATHLEEN MAIREAD (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MAIREAD
Last Name:ZACHERL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KATHLEEN
Other - Middle Name:MAIREAD
Other - Last Name:CUSICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 ALBANY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06120-2508
Mailing Address - Country:US
Mailing Address - Phone:860-249-9625
Mailing Address - Fax:860-808-1580
Practice Address - Street 1:500 ALBANY AVE
Practice Address - Street 2:DEPT OF OB/GYN
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06120-2508
Practice Address - Country:US
Practice Address - Phone:860-249-9625
Practice Address - Fax:860-808-1580
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT48502207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2022989Medicaid