Provider Demographics
NPI:1851741466
Name:ZLOCZOVER, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:ZLOCZOVER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:DAVID
Other - Last Name:ZLOCZOVER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:101 E OLNEY AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-2470
Mailing Address - Country:US
Mailing Address - Phone:215-456-1825
Mailing Address - Fax:215-456-5926
Practice Address - Street 1:7500 GERMANTOWN AVE STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-1668
Practice Address - Country:US
Practice Address - Phone:215-248-0112
Practice Address - Fax:215-248-1767
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD474575207Q00000X
MI4301110491207Q00000X
DEC1-0026062207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine