Provider Demographics
NPI:1598942187
Name:YAVITZ ZINCOF, ILAN GABRIEL (MD)
Entity Type:Individual
Prefix:
First Name:ILAN
Middle Name:GABRIEL
Last Name:YAVITZ ZINCOF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:275 VARNUM AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2109
Mailing Address - Country:US
Mailing Address - Phone:978-934-9220
Mailing Address - Fax:978-453-7771
Practice Address - Street 1:275 VARNUM AVE STE 203
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2109
Practice Address - Country:US
Practice Address - Phone:978-934-9220
Practice Address - Fax:978-453-7771
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-25
Last Update Date:2011-05-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA238493207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease