Provider Demographics
NPI:1477817187
Name:ZACHARIAH, MARCUS (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:
Last Name:ZACHARIAH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3750 CONVOY ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3741
Mailing Address - Country:US
Mailing Address - Phone:619-297-4481
Mailing Address - Fax:858-429-7666
Practice Address - Street 1:3750 CONVOY ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3741
Practice Address - Country:US
Practice Address - Phone:619-297-4481
Practice Address - Fax:858-429-7666
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35135874207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0401107Medicaid