Provider Demographics
NPI:1023076379
Name:ZIVIN, STEPHEN BRADLEY (MD)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:BRADLEY
Last Name:ZIVIN
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 1:81 OVERBROOK RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1934
Mailing Address - Country:US
Mailing Address - Phone:312-339-2022
Mailing Address - Fax:
Practice Address - Street 1:81 OVERBROOK RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-1934
Practice Address - Country:US
Practice Address - Phone:312-339-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4284162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101572078Medicaid
PA231955165OtherAETNA
PA30031939OtherKEYSTONE MERCY
PA2757678000OtherIBC
PAMD428416OtherHEALTH PARTNERS
PA1892659OtherHIGHMARK BLUE SHIELD
PA231955165OtherINTERGROUP SERVICES
PA2757678000OtherKHPE
PA9436362OtherPHCS
PA101572078OtherAMERICHOICE OF PA
PAPA7584OtherHEALTH NET
PAMD428416OtherHEALTH PARTNERS
PAPA7584OtherHEALTH NET