Provider Demographics
NPI:1912499146
Name:MASHAW, ZACHARY MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:MARK
Last Name:MASHAW
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 1:921 STATE ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13669-3347
Mailing Address - Country:US
Mailing Address - Phone:315-393-9268
Mailing Address - Fax:315-393-3541
Practice Address - Street 1:921 STATE ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3347
Practice Address - Country:US
Practice Address - Phone:315-393-9268
Practice Address - Fax:315-393-3541
Is Sole Proprietor?:No
Enumeration Date:2018-06-04
Last Update Date:2023-04-11
Deactivation Date:2022-04-06
Deactivation Code:
Reactivation Date:2022-04-26
Provider Licenses
StateLicense IDTaxonomies
NY304188207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine