Provider Demographics
NPI:1932543592
Name:ZACHAU, KATELYN MARIE BONAR (DO)
Entity Type:Individual
Prefix:
First Name:KATELYN
Middle Name:MARIE BONAR
Last Name:ZACHAU
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:KATELYN
Other - Middle Name:MARIE
Other - Last Name:BONAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:75 HOCKANUM BLVD
Mailing Address - Street 2:APT. 1821
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-4056
Mailing Address - Country:US
Mailing Address - Phone:919-724-5876
Mailing Address - Fax:
Practice Address - Street 1:315 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-5251
Practice Address - Country:US
Practice Address - Phone:860-533-0179
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-24
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1.055300207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine