Healthcare Provider Details

I. General information

NPI: 1912521550
Provider Name (Legal Business Name): ZARA IDREES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 08/26/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 NUTT RD
PHOENIXVILLE PA
19460-3906
US

IV. Provider business mailing address

PO BOX 13579
READING PA
19612-3579
US

V. Phone/Fax

Practice location:
  • Phone: 484-628-5455
  • Fax:
Mailing address:
  • Phone: 484-628-1324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number325127
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: