1225019946 NPI number — ANTHONY P ZOLLO D.O.

Table of content: ANTHONY P ZOLLO D.O. (NPI 1225019946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225019946 NPI number — ANTHONY P ZOLLO D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZOLLO
Provider First Name:
ANTHONY
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225019946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
124 SUNSET HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATESVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28625-2729
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-872-8711
Provider Business Mailing Address Fax Number:
704-872-5866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
124 SUNSET HILL ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STATESVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28625-2729
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-872-8711
Provider Business Practice Location Address Fax Number:
704-872-5866
Provider Enumeration Date:
11/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0102037126 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: 9701905 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 010112591 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2129939 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5586237 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN0122 . This is a "JOHN DEERE HEALTH (W/S)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010112516 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 891130N , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1130N . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 76912 . This is a "MEDCOST" identifier . This identifiers is of the category "OTHER".
  • Identifier: TN0105 . This is a "JOHN DEERE HEALTH (MA)" identifier . This identifiers is of the category "OTHER".
  • Identifier: 010112460 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166428 . This is a "ANTHEM (GALAX)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 167242 . This is a "ANTHEM (W/S)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2657722 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00208710 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 709406002 . This is a "CIGNA HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: TN0121 . This is a "JOHN DEERE HEALTH (GAL)" identifier . This identifiers is of the category "OTHER".




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