Provider Demographics
NPI:1578775706
Name:ZELMAN, MARVIN (MD)
Entity Type:Individual
Prefix:
First Name:MARVIN
Middle Name:
Last Name:ZELMAN
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 1:31 WOODLAND ST
Mailing Address - Street 2:1A
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06105-4335
Mailing Address - Country:US
Mailing Address - Phone:860-522-0426
Mailing Address - Fax:860-522-0709
Practice Address - Street 1:31 WOODLAND ST
Practice Address - Street 2:1A
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-4335
Practice Address - Country:US
Practice Address - Phone:860-522-0426
Practice Address - Fax:860-522-0709
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0144172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010014417CT01OtherINSURANCE
CTB83155Medicare UPIN