Provider Demographics
NPI:1124027552
Name:ZWETCHKENBAUM, JOHN F (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ZWETCHKENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 HOPE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5026
Mailing Address - Country:US
Mailing Address - Phone:401-751-1235
Mailing Address - Fax:401-751-4744
Practice Address - Street 1:1056 HOPE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5026
Practice Address - Country:US
Practice Address - Phone:401-751-1235
Practice Address - Fax:401-751-4744
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD07704207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002909Medicaid
RIE48181Medicare UPIN
RI9002909Medicaid
RI007059753Medicare PIN