Provider Demographics
NPI:1801886478
Name:ZINZUWADIA, BELLA N (MD)
Entity type:Individual
Prefix:
First Name:BELLA
Middle Name:N
Last Name:ZINZUWADIA
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:WV
Mailing Address - Zip Code:25813-0550
Mailing Address - Country:US
Mailing Address - Phone:304-255-1300
Mailing Address - Fax:304-255-5391
Practice Address - Street 1:703 RITTER DRIVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:WV
Practice Address - Zip Code:25813
Practice Address - Country:US
Practice Address - Phone:304-255-1300
Practice Address - Fax:304-255-5391
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV2114501OtherMAMSI
WV1052694OtherW COMP
WV550774633OtherTRICARE
WV550774633OtherTAX ID
WV001721267OtherBLUE CROSS
WV7410128OtherAETNA
WV6703073000OtherMEDICARE LAB
WV110209636OtherRR MCARE
WV210444OtherCARELINK
WVZ14012781Medicare ID - Type Unspecified
WVH11071Medicare UPIN
WV6000335000Medicare ID - Type Unspecified