Provider Demographics
NPI:1215918404
Name:ZAITER, PEDRO J (MD)
Entity type:Individual
Prefix:
First Name:PEDRO
Middle Name:J
Last Name:ZAITER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17722 KING WILLIAM CT
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-2307
Mailing Address - Country:US
Mailing Address - Phone:301-774-2554
Mailing Address - Fax:
Practice Address - Street 1:2041 GEORGIA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20060-0001
Practice Address - Country:US
Practice Address - Phone:202-865-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0048091207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00372187OtherRAILROAD MEDICARE
MD663501600Medicaid
VA1215918404Medicaid
MD762671100Medicaid
VA011788S46Medicare PIN
MDG17902Medicare UPIN
MDH733O427Medicare PIN
VA1215918404Medicaid