Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 35.125832 | OH |
Y | 2080P0203X | Pediatric Critical Care Doctor | 35.125832 | OH |
NPI | 1265792386 |
---|---|
Provider Name | Dr. Matthew William Zackoff |
First Address | Cincinnati, OH 45229-3026 |
Second Address | Cincinnati, OH 45229-3026 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2012 |
Last Update Date | 01/07/2019 |