Basic Information
| Provider Information | |||||||||
| NPI: | 1720288517 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZACHERL | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MAIREAD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CUSICK | ||||||||
| OtherFirstName: | KATHLEEN | ||||||||
| OtherMiddleName: | MAIREAD | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 500 ALBANY AVE | ||||||||
| Address2: | |||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061202508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602499625 | ||||||||
| FaxNumber: | 8608081580 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 ALBANY AVE | ||||||||
| Address2: | DEPT OF OB/GYN | ||||||||
| City: | HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061202508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8602499625 | ||||||||
| FaxNumber: | 8608081580 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2007 | ||||||||
| LastUpdateDate: | 05/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 48502 | CT | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 2022989 | 05 | CT | MEDICAID |