Healthcare Provider Details

I. General information

NPI: 1821027640
Provider Name (Legal Business Name): XIANFENG F ZHAO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 JEFFERSON AVE
MEMPHIS TN
38103-2807
US

IV. Provider business mailing address

PO BOX 64592
BALTIMORE MD
21264-4592
US

V. Phone/Fax

Practice location:
  • Phone: 901-545-7514
  • Fax: 901-302-2067
Mailing address:
  • Phone: 410-328-5555
  • Fax: 410-328-0929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberD0063352
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number68660
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: