Healthcare Provider Details

I. General information

NPI: 1477310498
Provider Name (Legal Business Name): ZACHARY CHARLES MORRISON RD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 DEBARTOLO PL STE 1200
YOUNGSTOWN OH
44512-7004
US

IV. Provider business mailing address

100 DEBARTOLO PL STE 200
YOUNGSTOWN OH
44512-6095
US

V. Phone/Fax

Practice location:
  • Phone: 234-287-6710
  • Fax: 234-287-6711
Mailing address:
  • Phone: 330-729-8145
  • Fax: 330-965-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberLD.7680
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberDN005651
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: