Provider Demographics
NPI:1811470008
Name:ZUKOWSKI, MARIA E (PA)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:E
Last Name:ZUKOWSKI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:E
Other - Last Name:CHOUINARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:7335 YANKEE RD STE 201
Mailing Address - Street 2:
Mailing Address - City:LIBERTY TWP
Mailing Address - State:OH
Mailing Address - Zip Code:45044-1253
Mailing Address - Country:US
Mailing Address - Phone:513-564-6818
Mailing Address - Fax:513-564-6819
Practice Address - Street 1:7335 YANKEE RD STE 201
Practice Address - Street 2:
Practice Address - City:LIBERTY TWP
Practice Address - State:OH
Practice Address - Zip Code:45044-1253
Practice Address - Country:US
Practice Address - Phone:513-564-6818
Practice Address - Fax:513-564-6819
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.005671363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0326736Medicaid