Healthcare Provider Details

I. General information

NPI: 1619791563
Provider Name (Legal Business Name): ZACHARY SCHOTT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2024
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 PROFESSIONAL PL # 103
BRIDGEPORT WV
26330-4599
US

IV. Provider business mailing address

207 GANDALF RD
MASONTOWN WV
26542-9023
US

V. Phone/Fax

Practice location:
  • Phone: 304-969-4885
  • Fax: 304-853-5859
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: ZACHARY SCHOTT
Title or Position: OWNER/PROVIDER
Credential: FNP-C
Phone: 304-518-1861