Provider Demographics
NPI:1871580597
Name:ZACARIAN, ALICE L (MD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:L
Last Name:ZACARIAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:355 WAVERLEY OAKS RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02452-8474
Mailing Address - Country:US
Mailing Address - Phone:781-647-6920
Mailing Address - Fax:781-891-0056
Practice Address - Street 1:355 WAVERLEY OAKS RD
Practice Address - Street 2:SUITE 200
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02452-8474
Practice Address - Country:US
Practice Address - Phone:781-647-6920
Practice Address - Fax:781-891-0056
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-03-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA158523207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3192741Medicaid
MAA29367Medicare ID - Type Unspecified