Healthcare Provider Details

I. General information

NPI: 1134430747
Provider Name (Legal Business Name): ANTHONY MARTIN ZIZZA III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2010
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 COMPUTER DR STE 301
WESTBOROUGH MA
01581-1790
US

IV. Provider business mailing address

12 PARKWAY DR
SAUGUS MA
01906-1957
US

V. Phone/Fax

Practice location:
  • Phone: 617-420-5316
  • Fax:
Mailing address:
  • Phone: 781-347-1380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number245455
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number257465
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: