Basic Information
Provider Information
NPI: 1023113941
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ZAVOSKI
FirstName: ROBERT
MiddleName: W
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 500 ALBANY AVE
Address2:  
City: HARTFORD
State: CT
PostalCode: 061202508
CountryCode: US
TelephoneNumber: 8602499625
FaxNumber: 8608081540
Practice Location
Address1: 26 QUEEN STREET
Address2:  
City: WORCESTER
State: MA
PostalCode: 016102473
CountryCode: US
TelephoneNumber: 5088607800
FaxNumber: 5088607925
Other Information
ProviderEnumerationDate: 09/14/2006
LastUpdateDate: 07/27/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 07/27/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208000000X032395CTN Allopathic & Osteopathic PhysiciansPediatrics 
208000000X291604MAY Allopathic & Osteopathic PhysiciansPediatrics 

No ID Information.


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