Provider Demographics
NPI:1386633196
Name:ZAGARELLA, MICHAEL JOSEPH (MA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:ZAGARELLA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W KING ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3204
Mailing Address - Country:US
Mailing Address - Phone:304-267-8220
Mailing Address - Fax:
Practice Address - Street 1:400 W KING ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3204
Practice Address - Country:US
Practice Address - Phone:304-267-8220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVA-0025231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0160831000Medicaid
WV0160831001Medicaid
WVAZ4051661Medicare ID - Type Unspecified
WV0160831000Medicaid
WVW40145Medicare UPIN