Basic Information
| Provider Information | |||||||||
| NPI: | 1760453708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOKO | ||||||||
| FirstName: | ZACHARY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32861 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212822861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103662660 | ||||||||
| FaxNumber: | 4103662662 | ||||||||
| Practice Location | |||||||||
| Address1: | 4419 FALLS RD STE D | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212111298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103623000 | ||||||||
| FaxNumber: | 4103662662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/28/2006 | ||||||||
| LastUpdateDate: | 07/28/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | D0029276 | MD | Y | Other Service Providers | Specialist |
No ID Information.