Healthcare Provider Details

I. General information

NPI: 1891703831
Provider Name (Legal Business Name): MRS. FATANEH M ZIARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 07/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVENUE SUITE 214
NEWARK DE
19702
US

IV. Provider business mailing address

2600 GLASGOW AVENUE SUITE 214
NEWARK DE
19702
US

V. Phone/Fax

Practice location:
  • Phone: 302-836-8533
  • Fax: 302-836-5159
Mailing address:
  • Phone: 302-836-8533
  • Fax: 302-836-5159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC10004255
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: