Provider Demographics
NPI:1548295678
Name:ZARRAGA-FORSYTH, IDA E (MD)
Entity type:Individual
Prefix:
First Name:IDA
Middle Name:E
Last Name:ZARRAGA-FORSYTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GOVE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1920
Mailing Address - Country:US
Mailing Address - Phone:617-569-5800
Mailing Address - Fax:617-568-4780
Practice Address - Street 1:10 GOVE ST
Practice Address - Street 2:
Practice Address - City:EAST BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1920
Practice Address - Country:US
Practice Address - Phone:617-569-5800
Practice Address - Fax:617-568-4780
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223058207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2112841Medicaid
MA486908OtherTUFTS HEALTH PLAN
263469OtherABIM CERT NUMBER
MA223058OtherMA PHYSICIAN LIC NUMBER
MAJ29557OtherBCBSMA PROVIDER ID
MA223058OtherMA PHYSICIAN LIC NUMBER
MAJ29557OtherBCBSMA PROVIDER ID
263469OtherABIM CERT NUMBER
BZ9298616OtherFED DEA