Provider Demographics
NPI:1932178613
Name:ZACHARIAH, ALVIN (MD)
Entity type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:ZACHARIAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:ALVIN
Other - Middle Name:
Other - Last Name:ZACHARIAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 280041
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94128-0041
Mailing Address - Country:US
Mailing Address - Phone:209-613-1282
Mailing Address - Fax:650-273-1706
Practice Address - Street 1:525 W ACACIA ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95203-2405
Practice Address - Country:US
Practice Address - Phone:209-613-1282
Practice Address - Fax:650-273-1706
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64060207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A640602Medicare ID - Type Unspecified
G91819Medicare UPIN
CAAP469XMedicare PIN