MEDICARE: DINO GEORGE ZACHARAKOS 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	207L00000X	Anesthesiology Physician	029653	CT
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	029653	CT

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	:	1831192723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINO GEORGE ZACHARAKOS MD

Provider Business Mailing Address
First Line	:	2 TRAP FALLS RD
Second Line	:	SUITE 414
City	:	SHELTON
State	:	CT
Zip	:	06484-4616
Country	:	US
Telephone Number	:	860-282-4128
Fax Number	:	860-289-0746

Provider Business Practice Location Address
First Line	:	99 E RIVER DR
Second Line	:	5TH FLOOR
City	:	EAST HARTFORD
State	:	CT
Zip	:	06108-3288
Country	:	US
Telephone Number	:	860-282-4128
Fax Number	:	860-289-0746

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/23/2015

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