Provider Demographics
NPI:1710083936
Name:ZAKLYNSKY, OREST (MD)
Entity Type:Individual
Prefix:
First Name:OREST
Middle Name:
Last Name:ZAKLYNSKY
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:PO BOX 16149
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-0697
Mailing Address - Country:US
Mailing Address - Phone:401-453-9625
Mailing Address - Fax:401-435-7069
Practice Address - Street 1:220 BELLEVUE AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3515
Practice Address - Country:US
Practice Address - Phone:401-849-1113
Practice Address - Fax:401-849-0410
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD05852208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI900267Medicaid
007058890Medicare PIN
RIC90300Medicare UPIN
RI900267Medicaid