Healthcare Provider Details

I. General information

NPI: 1194042481
Provider Name (Legal Business Name): RONALD ZVITI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2010
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 CONGRESS ST STE 300
PORTLAND ME
04102-3103
US

IV. Provider business mailing address

887 CONGRESS ST STE 300
PORTLAND ME
04102-3103
US

V. Phone/Fax

Practice location:
  • Phone: 207-662-5522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number264365
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberM-17035
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD21830
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: