Healthcare Provider Details

I. General information

NPI: 1881666808
Provider Name (Legal Business Name): DAWN M ZAPOTOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 ARCOLA RD MAIN LINE HEALTH CENTER
COLLEGEVILLE PA
19426-3954
US

IV. Provider business mailing address

PO BOX 191 PROVIDER ENROLLMENT DEPARTMENT
ROCKLAND DE
19732-0191
US

V. Phone/Fax

Practice location:
  • Phone: 484-565-8480
  • Fax: 610-487-1942
Mailing address:
  • Phone: 904-697-4201
  • Fax: 302-651-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD060422L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: