Provider Demographics
NPI:1962595447
Name:ZAMM, ALFRED VICTOR (MD)
Entity type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:VICTOR
Last Name:ZAMM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4234
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90264-4234
Mailing Address - Country:US
Mailing Address - Phone:310-457-4252
Mailing Address - Fax:310-457-4253
Practice Address - Street 1:29500 HEATHERCLIFF RD SPC 46
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-6046
Practice Address - Country:US
Practice Address - Phone:310-457-4252
Practice Address - Fax:310-457-4253
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY082532207KA0200X, 207N00000X
CAG86321207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00121155Medicaid
NY127601OtherEMPIRE B C/BS
NY127601Medicare ID - Type UnspecifiedMEDICARE
NYB02335Medicare UPIN
B02335Medicare UPIN