Provider Demographics
NPI:1366977415
Name:CHADNICK, ZACHARY (MD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:
Last Name:CHADNICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:115 N SUMTER ST STE 300
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-4967
Practice Address - Country:US
Practice Address - Phone:803-775-1550
Practice Address - Fax:803-775-7258
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2024-08-16
Deactivation Date:2017-11-27
Deactivation Code:
Reactivation Date:2017-12-07
Provider Licenses
StateLicense IDTaxonomies
390200000X
SC912312086S0129X
CT718282086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program