Provider Demographics
NPI:1245297977
Name:ZAVITSANOS, JAMES P (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:P
Last Name:ZAVITSANOS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 N WICKHAM RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-8660
Mailing Address - Country:US
Mailing Address - Phone:321-541-1746
Mailing Address - Fax:321-676-2613
Practice Address - Street 1:240 N WICKHAM RD STE 202
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-8660
Practice Address - Country:US
Practice Address - Phone:321-541-1746
Practice Address - Fax:321-676-2613
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53132207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048612400Medicaid
060008498OtherRAIL ROAD MEDICARE
FL023772700Medicaid