Healthcare Provider Details

I. General information

NPI: 1831359637
Provider Name (Legal Business Name): MARIO ALEXANDER ZACHARATOS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2008
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 ROUTE 28 STE A
WEST YARMOUTH MA
02673-4620
US

IV. Provider business mailing address

4950 COMMUNICATION AVE STE 100
BOCA RATON FL
33431-3308
US

V. Phone/Fax

Practice location:
  • Phone: 508-394-2017
  • Fax:
Mailing address:
  • Phone: 561-982-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number273629
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: