Healthcare Provider Details

I. General information

NPI: 1346773496
Provider Name (Legal Business Name): ZACHARY TODD SKABELUND M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/08/2022
Certification Date: 07/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 DESMOND ST
SAYRE PA
18840-2001
US

IV. Provider business mailing address

PO BOX 725
COOPERSTOWN NY
13326-0725
US

V. Phone/Fax

Practice location:
  • Phone: 570-887-3163
  • Fax:
Mailing address:
  • Phone: 607-547-3456
  • Fax: 607-547-6612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number310149-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD474122
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: