Provider Demographics
NPI:1336386309
Name:ZAVELSKY, ILYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:ZAVELSKY
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 1:12206 HUNTERS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-6968
Mailing Address - Country:US
Mailing Address - Phone:804-364-2727
Mailing Address - Fax:
Practice Address - Street 1:11127 JOURNAL PKWY
Practice Address - Street 2:STE 101
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3468
Practice Address - Country:US
Practice Address - Phone:540-775-6891
Practice Address - Fax:540-775-6894
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054332208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics