Provider Demographics
NPI:1417059973
Name:ZGRABIK, SCOTT DONALD (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:DONALD
Last Name:ZGRABIK
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 1:615 FULTON ST
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-2001
Mailing Address - Country:US
Mailing Address - Phone:419-734-3131
Mailing Address - Fax:419-732-4007
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:419-732-4007
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-056262207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH29680OtherANTHEM BCBS OF OHIO
OH0809334Medicaid
OH344441792057OtherMEDICAL MUTUAL OF OHIO
OH29680OtherANTHEM BCBS OF OHIO
OHZG7155141Medicare ID - Type Unspecified