MEDICARE: MR. JUAN CARLOS ZELAYA PA-C

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	363A00000X	Physician Assistant	C0001571	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578566790
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JUAN CARLOS ZELAYA PA-C

Provider Business Mailing Address
First Line	:	PO BOX 1978
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21802-1978
Country	:	US
Telephone Number	:	410-749-1015
Fax Number	:	410-749-0654

Provider Business Practice Location Address
First Line	:	305 10TH ST STE 104
Second Line	:
City	:	POCOMOKE CITY
State	:	MD
Zip	:	21851-1607
Country	:	US
Telephone Number	:	410-957-0273
Fax Number	:	410-957-0152

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/28/2024

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Directions to “ MR. JUAN CARLOS ZELAYA PA-C” Practice Location

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