Provider Demographics
NPI:1154327229
Name:ZAVELL, PETER J (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:ZAVELL
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 1:1212 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-4519
Mailing Address - Country:US
Mailing Address - Phone:843-319-6630
Mailing Address - Fax:843-676-1437
Practice Address - Street 1:1212 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4519
Practice Address - Country:US
Practice Address - Phone:843-319-6630
Practice Address - Fax:843-676-1437
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC020277207P00000X
SC20277207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC202774Medicaid
SC7095Medicare PIN
SC1162Medicare PIN
SC202774Medicaid