Provider Demographics
NPI:1174789507
Name:ZAYCOSKY, MICHAEL BRIAN (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:ZAYCOSKY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7176 W RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-2027
Mailing Address - Country:US
Mailing Address - Phone:814-413-7997
Mailing Address - Fax:814-413-7998
Practice Address - Street 1:7176 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:FAIRVIEW
Practice Address - State:PA
Practice Address - Zip Code:16415-2027
Practice Address - Country:US
Practice Address - Phone:814-413-7997
Practice Address - Fax:814-413-7998
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015047207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty