MEDICARE: DR. MADGE E ZACHARIAS MD

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	208000000X	Pediatrics Physician	0101039837	VA
2	2083P0901X	Public Health & General Preventive Medicine Physician	0101039837	VA
3	208D00000X	General Practice Physician	0101039837	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10348998	OTHER	VA	CAQH

General Provider Information

NPI Number	:	1396072609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MADGE E ZACHARIAS MD

Provider Business Mailing Address
First Line	:	1311 PALMYRA AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-4418
Country	:	US
Telephone Number	:	804-358-9539
Fax Number	:	804-358-9329

Provider Business Practice Location Address
First Line	:	1311 PALMYRA AVE
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-4418
Country	:	US
Telephone Number	:	804-358-9539
Fax Number	:	804-358-9329

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

Provider Enumeration Date	:	11/06/2009
Last Update Date	:	11/06/2009

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