Basic Information
| Provider Information | |||||||||
| NPI: | 1063489524 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ZAMA | ||||||||
| FirstName: | NCHE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 571 SAINT JOSEPHS BLVD | ||||||||
| Address2: | FL 2 | ||||||||
| City: | ELMIRA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 149013230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6072712050 | ||||||||
| FaxNumber: | 6072712099 | ||||||||
| Practice Location | |||||||||
| Address1: | 206 E BROWN ST | ||||||||
| Address2: | |||||||||
| City: | EAST STROUDSBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 183013006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5704205331 | ||||||||
| FaxNumber: | 5704228233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2006 | ||||||||
| LastUpdateDate: | 06/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | MD049700L | PA | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 208G00000X | 215259-1 | NY | N | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 0014325660008 | 05 | PA | MEDICAID | 0014325660009 | 05 | PA | MEDICAID | 0650047000 | 01 | PA | KEYSTONE IBC | OTHER | 741362 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 0014325660004 | 05 | PA | MEDICAID | 3416861 | 01 | PA | AETNA | OTHER | 01948801 | 05 | NY | MEDICAID |