Provider Demographics
NPI:1922129014
Name:RONALD A. ZLOTOFF, M.D., F.A.C.P., LLC
Entity Type:Organization
Organization Name:RONALD A. ZLOTOFF, M.D., F.A.C.P., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ZLOTOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP
Authorized Official - Phone:203-755-4515
Mailing Address - Street 1:140 GRANDVIEW AVE
Mailing Address - Street 2:LOWER LEVEL SUITE 4
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-2505
Mailing Address - Country:US
Mailing Address - Phone:203-755-4515
Mailing Address - Fax:203-755-8129
Practice Address - Street 1:140 GRANDVIEW AVE
Practice Address - Street 2:LOWER LEVEL SUITE 4
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-2505
Practice Address - Country:US
Practice Address - Phone:203-755-4515
Practice Address - Fax:203-755-8129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT010020649CT03OtherBCBS PROVIDER ID
CT001206499Medicaid
CT010020649CT03OtherBCBS PROVIDER ID
CTB84180Medicare UPIN