MEDICARE: DR. DOUGLAS P. ZMOLEK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	1711201	NY

General Provider Information

NPI Number	:	1477534667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS P. ZMOLEK M.D.

Provider Business Mailing Address
First Line	:	1001 W FAYETTE ST
Second Line	:	SUITE 400
City	:	SYRACUSE
State	:	NY
Zip	:	13204-2859
Country	:	US
Telephone Number	:	315-682-6600
Fax Number	:	315-682-0570

Provider Business Practice Location Address
First Line	:	4500 PEWTER LN
Second Line	:	BUILDLING 1
City	:	MANLIUS
State	:	NY
Zip	:	13104-9707
Country	:	US
Telephone Number	:	315-682-6600
Fax Number	:	315-682-0570

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	03/12/2021

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