Provider Demographics
NPI:1588601140
Name:ZAWODNY, ROBERT V
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:V
Last Name:ZAWODNY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64075
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4075
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:HEART CENTER - BURK BLDG 310
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-332-9752
Practice Address - Fax:410-332-0626
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031230207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS185 / 0011OtherBLUECHOICE
MDS793 / 423104-06OtherBC / BS OF MD
MD384091300Medicaid
B69871Medicare UPIN
MDS793 / 423104-06OtherBC / BS OF MD