Healthcare Provider Details

I. General information

NPI: 1598745747
Provider Name (Legal Business Name): DANIEL G ZAVADAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2006
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

923 RUSSELL DR
LEBANON PA
17042-7487
US

IV. Provider business mailing address

923 RUSSELL DR
LEBANON PA
17042-7487
US

V. Phone/Fax

Practice location:
  • Phone: 717-270-9004
  • Fax: 717-270-1677
Mailing address:
  • Phone: 717-270-9004
  • Fax: 717-270-1677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD055106L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: