Provider Demographics
NPI:1023128261
Name:ZAVOTSKY, DIANE (MD)
Entity type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:ZAVOTSKY
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 1:237 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920-4015
Mailing Address - Country:US
Mailing Address - Phone:207-672-4187
Mailing Address - Fax:207-672-3641
Practice Address - Street 1:237 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAM
Practice Address - State:ME
Practice Address - Zip Code:04920-4015
Practice Address - Country:US
Practice Address - Phone:207-672-4187
Practice Address - Fax:207-672-3641
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD12626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807278600Medicaid
ID1131929Medicare PIN
E66341Medicare UPIN