Basic Information
| Provider Information | |||||||||
| NPI: | 1518987361 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | S ZAIDI MD AND ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304527694 | ||||||||
| FaxNumber: | 3304527795 | ||||||||
| Practice Location | |||||||||
| Address1: | 2600 TUSCARAWAS ST W | ||||||||
| Address2: | SUITE 120 | ||||||||
| City: | CANTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 447084644 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3304527694 | ||||||||
| FaxNumber: | 3304527795 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/21/2006 | ||||||||
| LastUpdateDate: | 09/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | MCGRATH | ||||||||
| AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING COORDINATOR | ||||||||
| AuthorizedOfficialTelephone: | 3304795428 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2433361 | 05 | OH | MEDICAID |