Healthcare Provider Details

I. General information

NPI: 1740267541
Provider Name (Legal Business Name): DEBORAH ZUCKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 MOUNT AUBURN ST
CAMBRIDGE MA
02138-5502
US

IV. Provider business mailing address

1 ARSENAL MARKET PL
WATERTOWN MA
02472-5018
US

V. Phone/Fax

Practice location:
  • Phone: 617-499-5065
  • Fax: 617-499-5686
Mailing address:
  • Phone: 617-673-1851
  • Fax: 617-499-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number73516
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: