Healthcare Provider Details

I. General information

NPI: 1861782187
Provider Name (Legal Business Name): ZACHARY NAYAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2011
Last Update Date: 05/19/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2360 W JOPPA RD STE 210
LUTHERVILLE MD
21093-4664
US

IV. Provider business mailing address

201 N BELNORD AVE
BALTIMORE MD
21224-1202
US

V. Phone/Fax

Practice location:
  • Phone: 410-583-2890
  • Fax:
Mailing address:
  • Phone: 309-533-3602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD7984
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0079487
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: