Healthcare Provider Details

I. General information

NPI: 1013988781
Provider Name (Legal Business Name): MICHAEL J ZUGAREK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 02/17/2022
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

397 LITTLE NECK RD STE 120
VIRGINIA BEACH VA
23452-5774
US

IV. Provider business mailing address

397 LITTLE NECK RD STE 120
VIRGINIA BEACH VA
23452-5774
US

V. Phone/Fax

Practice location:
  • Phone: 757-395-1600
  • Fax: 757-961-9359
Mailing address:
  • Phone: 757-395-1600
  • Fax: 757-961-9359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number0110840802
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110840802
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: