Healthcare Provider Details

I. General information

NPI: 1508109364
Provider Name (Legal Business Name): ZACHARY JOSEPH COFFMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2013
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 BLYTHE BLVD STE 500
CHARLOTTE NC
28203-5812
US

IV. Provider business mailing address

1001 BLYTHE BLVD STE 500
CHARLOTTE NC
28203-5863
US

V. Phone/Fax

Practice location:
  • Phone: 704-373-1813
  • Fax:
Mailing address:
  • Phone: 704-373-1813
  • Fax: 704-342-5871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME145837
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number321914
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberME145837
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberME145837
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number321914
License Number StateNC
# 6
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number321914
License Number StateNC
# 7
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: