Provider Demographics
NPI:1811183056
Name:CHEMALY, MARIANA ZACHARIAS ANDRE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIANA
Middle Name:ZACHARIAS ANDRE
Last Name:CHEMALY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:MARIANA
Other - Middle Name:ZACHARIAS
Other - Last Name:ANDRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:45 PALMER ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-1834
Mailing Address - Country:US
Mailing Address - Phone:978-970-1607
Mailing Address - Fax:978-970-1115
Practice Address - Street 1:45 PALMER ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1834
Practice Address - Country:US
Practice Address - Phone:978-970-1607
Practice Address - Fax:978-970-1115
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA238062207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine