Basic Information
Provider Information
NPI: 1033173257
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZACCHEO
FirstName: MATTHEW
MiddleName: V
NamePrefix: DR.
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 S FRONT ST
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171012010
CountryCode: US
TelephoneNumber: 7172318772
FaxNumber: 7172318435
Practice Location
Address1: 111 S FRONT ST
Address2:  
City: HARRISBURG
State: PA
PostalCode: 171012010
CountryCode: US
TelephoneNumber: 7172318772
FaxNumber: 7172318435
Other Information
ProviderEnumerationDate: 04/14/2006
LastUpdateDate: 08/14/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/14/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XOS012450PAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RC0200X5101018545MIN Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
207RC0200XOS012450PAY Allopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine

ID Information
IDTypeStateIssuerDescription
103317326705MI MEDICAID
107110401WVW. VIRGINIA WORKERS COMPOTHER
101057996000205PA MEDICAID
19761601PAUNISONOTHER
P0038052201PARR MEDICAREOTHER
141796113701MIBCBSM - BMH TAX IDOTHER
142775601PAAETNAOTHER
41033701PAUPMCOTHER
0002718640201NYUNIVERAOTHER
154052701PAGATEWAYOTHER
270289201OHOH MEDICAIDOTHER
0283379601NYNY MEDICAIDOTHER
141796113701MIBCBSM - BMHOTHER
125530435805MI MEDICAID
163376101PABLUE SHIELDOTHER


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