Provider Demographics
NPI:1871976290
Name:ZACHARJASZ, ALYSSA L (DPM)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:ZACHARJASZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:L
Other - Last Name:FAGG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1229 C AVE E
Mailing Address - Street 2:
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-4246
Mailing Address - Country:US
Mailing Address - Phone:641-672-3330
Mailing Address - Fax:
Practice Address - Street 1:1229 C AVE E
Practice Address - Street 2:
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577
Practice Address - Country:US
Practice Address - Phone:641-672-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000331A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery