Basic Information
| Provider Information | |||||||||
| NPI: | 1932543592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZACHAU | ||||||||
| FirstName: | KATELYN | ||||||||
| MiddleName: | MARIE BONAR | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BONAR | ||||||||
| OtherFirstName: | KATELYN | ||||||||
| OtherMiddleName: | MARIE | ||||||||
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| OtherCredential: | D.O. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 75 HOCKANUM BLVD | ||||||||
| Address2: | APT. 1821 | ||||||||
| City: | VERNON | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060664056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197245876 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 315 E CENTER ST | ||||||||
| Address2: | |||||||||
| City: | MANCHESTER | ||||||||
| State: | CT | ||||||||
| PostalCode: | 060405251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605330179 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2013 | ||||||||
| LastUpdateDate: | 07/12/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 1.055300 | CT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.