Provider Demographics
NPI:1962759308
Name:ANTI-AGING & AESTHETIC MEDICAL CENTER
Entity type:Organization
Organization Name:ANTI-AGING & AESTHETIC MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ZACCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:919-362-5910
Mailing Address - Street 1:410 E WILLIAMS ST
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-2149
Mailing Address - Country:US
Mailing Address - Phone:919-362-5910
Mailing Address - Fax:919-362-0071
Practice Address - Street 1:410 E WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-2149
Practice Address - Country:US
Practice Address - Phone:919-362-5910
Practice Address - Fax:919-362-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-03
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC96-00789174400000X, 204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Multi-Specialty