Provider Demographics
NPI:1003807082
Name:ZITTEL, GREGORY A (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:ZITTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:719 RODEL CV STE 1015
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5716
Mailing Address - Country:US
Mailing Address - Phone:407-302-3133
Mailing Address - Fax:407-330-4690
Practice Address - Street 1:719 RODEL CV STE 1015
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-5716
Practice Address - Country:US
Practice Address - Phone:407-302-3133
Practice Address - Fax:407-330-4690
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME67849207VG0400X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL379946800Medicaid
FL379946800Medicaid
G11792Medicare UPIN