MEDICARE: DR. ALBERT ANTHONY ZACHIK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	D21222	MD

General Provider Information

NPI Number	:	1235121682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALBERT ANTHONY ZACHIK M.D.

Provider Business Mailing Address
First Line	:	12420 OVER RIDGE RD
Second Line	:
City	:	POTOMAC
State	:	MD
Zip	:	20854-3046
Country	:	US
Telephone Number	:	301-340-2975
Fax Number	:

Provider Business Practice Location Address
First Line	:	5614 SHIELDS DR
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20817-3532
Country	:	US
Telephone Number	:	301-530-4664
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2005
Last Update Date	:	07/08/2007

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