MEDICARE: DR. AVEEN BABU ZACHARIAH D.O.

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	207Q00000X	Family Medicine Physician	P7230	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12707279	OTHER		CAQH

General Provider Information

NPI Number	:	1912270992
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AVEEN BABU ZACHARIAH D.O.

Provider Business Mailing Address
First Line	:	4515 SETON CENTER PKWY STE 215
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-5785
Country	:	US
Telephone Number	:	512-231-5506
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	3651 WESLAYAN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77027-6833
Country	:	US
Telephone Number	:	713-835-3791
Fax Number	:

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

Provider Enumeration Date	:	02/21/2012
Last Update Date	:	06/02/2017

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