Healthcare Provider Details

I. General information

NPI: 1861603524
Provider Name (Legal Business Name): CHAD CHARLES ZATEZALO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 02/15/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 CONNECTICUT AVE STE 640
CHEVY CHASE MD
20815-9904
US

IV. Provider business mailing address

8401 CONNECTICUT AVE STE 640
CHEVY CHASE MD
20815-9904
US

V. Phone/Fax

Practice location:
  • Phone: 301-304-6600
  • Fax: 301-304-6601
Mailing address:
  • Phone: 301-304-6600
  • Fax: 301-304-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMT189272
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD74823
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: