Provider Demographics
NPI:1881666808
Name:ZAPOTOK, DAWN M (MD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:M
Last Name:ZAPOTOK
Suffix:
Gender:F
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 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:904-697-4201
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:599 ARCOLA RD
Practice Address - Street 2:MAIN LINE HEALTH CENTER
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-3954
Practice Address - Country:US
Practice Address - Phone:484-565-8480
Practice Address - Fax:610-487-1942
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060422L208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G61533Medicare UPIN
PA001655614Medicaid
G61533Medicare UPIN
PA232359401OtherMAIN LINE HEALTHCARE