Provider Demographics
NPI:1194708149
Name:ZACCARIA, JAMES JOSEPH (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:JOSEPH
Last Name:ZACCARIA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 E HAVERFORD RD FL 3
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3838
Mailing Address - Country:US
Mailing Address - Phone:610-642-5040
Mailing Address - Fax:610-642-5042
Practice Address - Street 1:931 E HAVERFORD RD FL 3
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3838
Practice Address - Country:US
Practice Address - Phone:610-642-5040
Practice Address - Fax:610-642-5042
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004554L213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001891783Medicaid
PA001891783Medicaid
PA047820VKWMedicare PIN