Healthcare Provider Details

I. General information

NPI: 1205106648
Provider Name (Legal Business Name): ABRAHAM SOLOMON ZUCKERBROD O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2012
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860B REISTERSTOWN RD
BALTIMORE MD
21208-1335
US

IV. Provider business mailing address

1860B REISTERSTOWN RD
BALTIMORE MD
21208-1335
US

V. Phone/Fax

Practice location:
  • Phone: 410-864-2526
  • Fax: 410-230-1221
Mailing address:
  • Phone: 410-864-2526
  • Fax: 410-230-1221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberTA2257
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2257
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: