Provider Demographics
NPI:1205984796
Name:ZOLLICOFFER, MICHAEL L (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:ZOLLICOFFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2605 BANISTER RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-6505
Mailing Address - Country:US
Mailing Address - Phone:410-542-1725
Mailing Address - Fax:410-542-7468
Practice Address - Street 1:2605 BANISTER RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-6505
Practice Address - Country:US
Practice Address - Phone:410-542-1725
Practice Address - Fax:410-542-7468
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00366342080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211691000Medicaid