Provider Demographics
NPI:1457509143
Name:ZLOTOGORSKI, MICHAL (BA)
Entity Type:Individual
Prefix:
First Name:MICHAL
Middle Name:
Last Name:ZLOTOGORSKI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:MICHAL
Other - Middle Name:
Other - Last Name:WOHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1145 SAGAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-5503
Mailing Address - Country:US
Mailing Address - Phone:603-431-6703
Mailing Address - Fax:603-430-3753
Practice Address - Street 1:1145 SAGAMORE AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5503
Practice Address - Country:US
Practice Address - Phone:603-431-6703
Practice Address - Fax:603-430-3753
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH7706655Y0NH01OtherBHN
NH99003227Medicaid
NH99003227Medicaid