Provider Demographics
NPI:1588733109
Name:BUSH, ZACHARY M (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:M
Last Name:BUSH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3048 ALBERENE CHURCH LN
Mailing Address - Street 2:
Mailing Address - City:ESMONT
Mailing Address - State:VA
Mailing Address - Zip Code:22937-1516
Mailing Address - Country:US
Mailing Address - Phone:434-566-7628
Mailing Address - Fax:
Practice Address - Street 1:415 RAY C HUNT DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-2980
Practice Address - Country:US
Practice Address - Phone:434-924-1825
Practice Address - Fax:434-924-9616
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101239018207R00000X, 207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1588733109Medicaid