Provider Demographics
NPI:1760471403
Name:ZEDALIS, DONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:
Last Name:ZEDALIS
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 1:120 PONDEROSA DR STE B
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6599
Mailing Address - Country:US
Mailing Address - Phone:540-382-1165
Mailing Address - Fax:540-382-2614
Practice Address - Street 1:120 PONDEROSA DR STE B
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073
Practice Address - Country:US
Practice Address - Phone:540-382-1165
Practice Address - Fax:540-382-2614
Is Sole Proprietor?:No
Enumeration Date:2005-10-15
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045194207K00000X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA072311OtherANTHEM
VA233711OtherALLIANCE PPO/MAMSI
VA333711OtherALLIANCE/MAMSI (SLEEP)
VA006053238OtherVIRGINIA PREMIER
VA006053238Medicaid
VAE44907Medicare UPIN
VA072311OtherANTHEM