MEDICARE: MAMMEN P ZACHARIAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RI0011X	Interventional Cardiology Physician	ME41759	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154300150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAMMEN P ZACHARIAH MD

Provider Business Mailing Address
First Line	:	1841 NE 45TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5117
Country	:	US
Telephone Number	:	954-820-4200
Fax Number	:	954-678-9533

Provider Business Practice Location Address
First Line	:	1841 NE 45TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-5117
Country	:	US
Telephone Number	:	954-820-4200
Fax Number	:	954-678-9533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	08/20/2025

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