Healthcare Provider Details

I. General information

NPI: 1790741189
Provider Name (Legal Business Name): ZACK T. PERDUE III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 04/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2006 HEALTH CAMPUS DR
HARRISONBURG VA
22801-8679
US

IV. Provider business mailing address

PO BOX 1430
HARRISONBURG VA
22803-1430
US

V. Phone/Fax

Practice location:
  • Phone: 540-689-5400
  • Fax: 757-579-8568
Mailing address:
  • Phone: 540-564-7084
  • Fax: 540-564-6847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101038376
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: