Basic Information
| Provider Information | |||||||||
| NPI: | 1558749747 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZEVIN | ||||||||
| FirstName: | BORIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 700 ACKERMAN ROAD | ||||||||
| Address2: | SUITE 570 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432021579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142937399 | ||||||||
| FaxNumber: | 6142937852 | ||||||||
| Practice Location | |||||||||
| Address1: | 4830 KNIGHTSBRIDGE BLVD | ||||||||
| Address2: | SUITE J | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933230 | ||||||||
| FaxNumber: | 6142934030 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2015 | ||||||||
| LastUpdateDate: | 03/10/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 35125536 | OH | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | P01576500 | 01 | OH | RAILROAD MEDICARE | OTHER | 0131581 | 05 | OH | MEDICAID |