Healthcare Provider Details

I. General information

NPI: 1285602243
Provider Name (Legal Business Name): DAVID JAY ZUCKERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 MEDICAL CENTER DR STE. #530
ROCKVILLE MD
20850-3320
US

IV. Provider business mailing address

1401 CHURCH ST NW APT. # 404
WASHINGTON DC
20005-1970
US

V. Phone/Fax

Practice location:
  • Phone: 301-279-7622
  • Fax: 301-279-7624
Mailing address:
  • Phone: 202-986-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0038315
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: