Healthcare Provider Details

I. General information

NPI: 1740529577
Provider Name (Legal Business Name): FATANEH M ZIARI, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2013
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 GLASGOW AVE SUITE 212
NEWARK DE
19702-4773
US

IV. Provider business mailing address

2600 GLASGOW AVE SUITE 212
NEWARK DE
19702-4773
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 Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberC10004255
License Number StateDE

VIII. Authorized Official

Name: DR. FATANEH M ZIARI
Title or Position: PRESIDENT, OWNER
Credential: M.D.
Phone: 302-354-2419