Healthcare Provider Details

I. General information

NPI: 1700828225
Provider Name (Legal Business Name): CARLA J ZACHER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 08/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

828 KIRKWOOD MALL
BISMARCK ND
58504-5752
US

IV. Provider business mailing address

401 N 9TH ST
BISMARCK ND
58501-4507
US

V. Phone/Fax

Practice location:
  • Phone: 701-530-6000
  • Fax: 701-530-6430
Mailing address:
  • Phone: 701-530-6000
  • Fax: 701-530-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number8228
License Number StateND

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10944
Identifier TypeMEDICAID
Identifier StateND
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: