Provider Demographics
NPI:1295729317
Name:TOTODOVA, ZINOVIYA (MD)
Entity type:Individual
Prefix:DR
First Name:ZINOVIYA
Middle Name:
Last Name:TOTODOVA
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 1:4481 SUGAR MAPLE DRIVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45433
Mailing Address - Country:US
Mailing Address - Phone:937-257-9926
Mailing Address - Fax:937-257-1529
Practice Address - Street 1:4481 SUGAR MAPLE DRIVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45433
Practice Address - Country:US
Practice Address - Phone:937-257-9926
Practice Address - Fax:937-257-1529
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI46023-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34472300Medicaid
WII02954Medicare UPIN
WI01790-0001Medicare ID - Type UnspecifiedGROUP AND SEQUENCE NUMBER