Healthcare Provider Details

I. General information

NPI: 1093133084
Provider Name (Legal Business Name): ZACHARY THOMAS EWART M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2014
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 BRIDGE ST STE 202
DANVILLE VA
24541-1222
US

IV. Provider business mailing address

109 BRIDGE ST STE 202
DANVILLE VA
24541-1222
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-5964
  • Fax:
Mailing address:
  • Phone: 434-792-5964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101277331
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: