Healthcare Provider Details

I. General information

NPI: 1457542243
Provider Name (Legal Business Name): ANNE CLARICE ZAYDON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 MULBERRY ST
SCRANTON PA
18510-2408
US

IV. Provider business mailing address

1601 MADISON AVE
DUNMORE PA
18509-2033
US

V. Phone/Fax

Practice location:
  • Phone: 570-342-9130
  • Fax:
Mailing address:
  • Phone: 570-343-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number019953E
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number019953E
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: