MEDICARE: DR. TAMARA ZACH 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	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	44393	AZ
2	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician	252479	NY
3	2084N0402X	Neurology with Special Qualifications in Child Neurology Physician	44393	AZ

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	:	1962638254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAMARA ZACH M.D.

Provider Business Mailing Address
First Line	:	22044 N 44TH ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6104
Country	:	US
Telephone Number	:	623-257-7673
Fax Number	:	602-865-4507

Provider Business Practice Location Address
First Line	:	22044 N 44TH ST STE 200
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-6104
Country	:	US
Telephone Number	:	623-257-7673
Fax Number	:	623-257-7344

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

Provider Enumeration Date	:	06/01/2009
Last Update Date	:	02/15/2024

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