Healthcare Provider Details

I. General information

NPI: 1043313356
Provider Name (Legal Business Name): JONATHAN B ZUCKERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FODEN ROAD WEST BUILDING SUITE 103
SOUTH PORTLAND ME
04106
US

IV. Provider business mailing address

100 FODEN ROAD WEST BUILDING SUITE 103
SOUTH PORTLAND ME
04106
US

V. Phone/Fax

Practice location:
  • Phone: 207-828-1122
  • Fax: 207-828-0188
Mailing address:
  • Phone: 207-828-1122
  • Fax: 207-828-0188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberMD15233
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: