Healthcare Provider Details

I. General information

NPI: 1780211292
Provider Name (Legal Business Name): ANTHONY MICHAEL DEL ZOTTO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3110 MACCORKLE AVE SE
CHARLESTON WV
25304-1210
US

IV. Provider business mailing address

3805 GULF BLVD APT 305
ST PETE BEACH FL
33706-3952
US

V. Phone/Fax

Practice location:
  • Phone: 304-388-6597
  • Fax:
Mailing address:
  • Phone: 408-850-4687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number4201
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: