Provider Demographics
NPI:1720821952
Name:MADDOX, ZACHARY RICHARD (PA-C)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:RICHARD
Last Name:MADDOX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HEALTHCARE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:BIDDEFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04005-9445
Mailing Address - Country:US
Mailing Address - Phone:207-282-3666
Mailing Address - Fax:207-294-3552
Practice Address - Street 1:9 HEALTHCARE DR STE 105
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-9445
Practice Address - Country:US
Practice Address - Phone:207-282-3666
Practice Address - Fax:207-294-3552
Is Sole Proprietor?:No
Enumeration Date:2024-06-15
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT006861363A00000X
MEPA2940363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant