Healthcare Provider Details

I. General information

NPI: 1649739657
Provider Name (Legal Business Name): MARIAN ZGODINSKI DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 11/13/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29055 CLEMENS RD UNIT A
WESTLAKE OH
44145-1135
US

IV. Provider business mailing address

PO BOX 844020
DALLAS TX
75284-4020
US

V. Phone/Fax

Practice location:
  • Phone: 216-450-1613
  • Fax:
Mailing address:
  • Phone: 216-450-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34015879
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: