MEDICARE: ALICE L ZACARIAN 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	207R00000X	Internal Medicine Physician	158523	MA

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	:	1871580597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALICE L ZACARIAN M.D.

Provider Business Mailing Address
First Line	:	355 WAVERLEY OAKS RD
Second Line	:	SUITE 200
City	:	WALTHAM
State	:	MA
Zip	:	02452-8474
Country	:	US
Telephone Number	:	781-647-6920
Fax Number	:	781-891-0056

Provider Business Practice Location Address
First Line	:	355 WAVERLEY OAKS RD
Second Line	:	SUITE 200
City	:	WALTHAM
State	:	MA
Zip	:	02452-8474
Country	:	US
Telephone Number	:	781-647-6920
Fax Number	:	781-891-0056

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	03/13/2014

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