Provider Demographics
NPI:1144673823
Name:DILLINGHAM, ZECHARIAH TANNER (MD)
Entity type:Individual
Prefix:DR
First Name:ZECHARIAH
Middle Name:TANNER
Last Name:DILLINGHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:N
Other - Middle Name:
Other - Last Name:A
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10 GENERAL GREENE AVE
Mailing Address - Street 2:BLDG 42, MILITARY NUTRITION DIVISION
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760
Mailing Address - Country:US
Mailing Address - Phone:508-206-2458
Mailing Address - Fax:
Practice Address - Street 1:10 GENERAL GREENE AVE
Practice Address - Street 2:BLDG 42, MILITARY NUTRITION DIVISION
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-5007
Practice Address - Country:US
Practice Address - Phone:508-206-2458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-19
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NE30897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAVAD 000Medicare UPIN