Provider Demographics
NPI:1306803648
Name:ZERVOS, JOHN C (DPM)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:ZERVOS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 KENYON AVE
Mailing Address - Street 2:SOUTH COUNTY MEDICAL OFFICE BUILDING
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879
Mailing Address - Country:US
Mailing Address - Phone:401-789-8912
Mailing Address - Fax:401-782-8702
Practice Address - Street 1:70 KENYON AVE
Practice Address - Street 2:SOUTH COUNTY MEDICAL OFFICE BUILDING SUITE #212
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-8912
Practice Address - Fax:401-782-8702
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI229213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7010181Medicaid
RI203282OtherBLUE CHIP
RI70160OtherBCBS
RIJZ04165Medicaid
480027420OtherRR MCR
480027420OtherRR MCR
RI7010181Medicaid
T53538Medicare UPIN