Healthcare Provider Details

I. General information

NPI: 1396072609
Provider Name (Legal Business Name): MADGE E ZACHARIAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2009
Last Update Date: 11/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 PALMYRA AVE
RICHMOND VA
23227-4418
US

IV. Provider business mailing address

1311 PALMYRA AVE
RICHMOND VA
23227-4418
US

V. Phone/Fax

Practice location:
  • Phone: 804-358-9539
  • Fax: 804-358-9329
Mailing address:
  • Phone: 804-358-9539
  • Fax: 804-358-9329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101039837
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number0101039837
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101039837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: