Provider Demographics
NPI:1619959053
Name:ZETTERVALL, DONALD KEVIN (RPH, CDE, CDM)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:KEVIN
Last Name:ZETTERVALL
Suffix:
Gender:M
Credentials:RPH, CDE, CDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BOSTON POST RD
Mailing Address - Street 2:SUITE 2 THE DIABETES CENTER
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-1548
Mailing Address - Country:US
Mailing Address - Phone:860-388-6677
Mailing Address - Fax:860-388-3256
Practice Address - Street 1:134 BOSTON POST RD
Practice Address - Street 2:SUITE 2 THE DIABETES CENTER
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-1548
Practice Address - Country:US
Practice Address - Phone:860-388-6677
Practice Address - Fax:860-388-3256
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0901-8462174400000X
CT5567183500000X
VT0330002686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV6291OtherHEALTHNET