Basic Information
| Provider Information | |||||||||
| NPI: | 1497140214 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZHAO | ||||||||
| FirstName: | CHARLIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 EAST MAIN STREET | ||||||||
| Address2: | MEDICAL AFFAIRS | ||||||||
| City: | MT. KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661200 | ||||||||
| FaxNumber: | 9146661965 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 EAST MAIN STREET | ||||||||
| Address2: | MEDICAL AFFAIRS | ||||||||
| City: | MT. KISCO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10549 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9146661200 | ||||||||
| FaxNumber: | 9146661965 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2015 | ||||||||
| LastUpdateDate: | 02/25/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 64661 | CT | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 296844 | NY | N | Allopathic & Osteopathic Physicians | Family Medicine | 208M00000X | 64661 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 296844 | NY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.