Healthcare Provider Details

I. General information

NPI: 1023128261
Provider Name (Legal Business Name): DIANE ZAVOTSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 MAIN ST
BINGHAM ME
04920-4015
US

IV. Provider business mailing address

237 MAIN ST
BINGHAM ME
04920-4015
US

V. Phone/Fax

Practice location:
  • Phone: 207-672-4187
  • Fax: 207-672-3641
Mailing address:
  • Phone: 207-672-4187
  • Fax: 207-672-3641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD12626
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: