Provider Demographics
NPI:1366430357
Name:ZOLAN, JOHN A (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:ZOLAN
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:NAVAL BRANCH HEALTH CLINIC 1 WAHOO AVENUE
Mailing Address - Street 2:BUILDING # 449
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06349-5600
Mailing Address - Country:US
Mailing Address - Phone:860-694-5870
Mailing Address - Fax:860-694-2101
Practice Address - Street 1:NAVAL BRANCH HEALTH CLINIC 1 WAHOO AVENUE
Practice Address - Street 2:BUILDING #449
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06349-5600
Practice Address - Country:US
Practice Address - Phone:860-694-5870
Practice Address - Fax:860-694-2101
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2023-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZAZ27496174400000X
CAC523942084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH11023Medicare UPIN
CAWC52394AMedicare PIN
AZH-11023Medicare UPIN