Healthcare Provider Details

I. General information

NPI: 1801867056
Provider Name (Legal Business Name): GEOFFREY M. ZUCKER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MAIN ST
FLORENCE MA
01062-3158
US

IV. Provider business mailing address

10 MAIN ST
FLORENCE MA
01062-3158
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-8910
  • Fax: 413-584-7270
Mailing address:
  • Phone: 413-586-8910
  • Fax: 413-584-7270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number50657
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: