Provider Demographics
NPI:1154594695
Name:JOSEPH K ZACHARIAH, DO, PC
Entity type:Organization
Organization Name:JOSEPH K ZACHARIAH, DO, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:ZACHARIAH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:602-791-8100
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85380-0789
Mailing Address - Country:US
Mailing Address - Phone:602-486-5956
Mailing Address - Fax:623-374-2321
Practice Address - Street 1:4723 E DESERT PARK PL
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2949
Practice Address - Country:US
Practice Address - Phone:602-486-5956
Practice Address - Fax:623-374-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-04
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3216207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ379207Medicaid
AZ64162Medicare PIN
AZE92710Medicare UPIN