Healthcare Provider Details

I. General information

NPI: 1639147077
Provider Name (Legal Business Name): JOEL BRUCE ZIVOT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 23RD ST NW SUITE G- 2902
WASHINGTON DC
20037-2342
US

IV. Provider business mailing address

900 23RD ST NW SUITE G- 2902
WASHINGTON DC
20037-2342
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-4705
  • Fax:
Mailing address:
  • Phone: 202-715-4705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD035783
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35. 065870
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: