Provider Demographics
NPI:1740529577
Name:FATANEH M ZIARI, MD, PA
Entity type:Organization
Organization Name:FATANEH M ZIARI, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FATANEH
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZIARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-354-2419
Mailing Address - Street 1:2600 GLASGOW AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-4773
Mailing Address - Country:US
Mailing Address - Phone:302-836-8533
Mailing Address - Fax:302-836-5159
Practice Address - Street 1:2600 GLASGOW AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-4773
Practice Address - Country:US
Practice Address - Phone:302-836-8533
Practice Address - Fax:302-836-5159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC100042552080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty