Healthcare Provider Details

I. General information

NPI: 1124027552
Provider Name (Legal Business Name): JOHN F ZWETCHKENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1056 HOPE ST
PROVIDENCE RI
02906-5026
US

IV. Provider business mailing address

1056 HOPE ST
PROVIDENCE RI
02906-5026
US

V. Phone/Fax

Practice location:
  • Phone: 401-751-1235
  • Fax: 401-751-4744
Mailing address:
  • Phone: 401-751-1235
  • Fax: 401-751-4744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberMD07704
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: