Provider Demographics
NPI:1831359637
Name:ZACHARATOS, MARIO ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALEXANDER
Last Name:ZACHARATOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4950 COMMUNICATION AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-3308
Mailing Address - Country:US
Mailing Address - Phone:561-982-4300
Mailing Address - Fax:
Practice Address - Street 1:349 ROUTE 28 STE A
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-4620
Practice Address - Country:US
Practice Address - Phone:508-394-2017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-15
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273629207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2965359Medicaid
OH2965359Medicaid