Healthcare Provider Details

I. General information

NPI: 1174664320
Provider Name (Legal Business Name): VLADISLAV ZAKHAROV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 CAMPBELL AVE # 1-165
WEST HAVEN CT
06516-2770
US

IV. Provider business mailing address

950 CAMPBELL AVE BLDG 1, ROOM 1-165
WEST HAVEN CT
06516-2770
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-7511
  • Fax:
Mailing address:
  • Phone: 203-932-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number54082
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: