Healthcare Provider Details

I. General information

NPI: 1366500894
Provider Name (Legal Business Name): JOHN ZAGER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 BERWYN HOUSE RD SUITE 105
COLLEGE PARK MD
20740-2474
US

IV. Provider business mailing address

9029 49TH PL
COLLEGE PARK MD
20740-1834
US

V. Phone/Fax

Practice location:
  • Phone: 301-537-7284
  • Fax: 301-474-0432
Mailing address:
  • Phone: 301-537-7284
  • Fax: 301-474-0432

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number02029
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: