Provider Demographics
NPI:1528049327
Name:ZWOLINSKI, RALPH JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:JOSEPH
Last Name:ZWOLINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1673 MASON AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5515
Mailing Address - Country:US
Mailing Address - Phone:386-274-7118
Mailing Address - Fax:386-274-6173
Practice Address - Street 1:5111 S RIDGEWOOD AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-5169
Practice Address - Country:US
Practice Address - Phone:386-763-4484
Practice Address - Fax:386-763-1288
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000046005174400000X
FLME 460052084N0400X, 208VP0000X
FLNE 460052084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64543OtherBC/BS
FM098653400Medicaid
FLP00827133OtherRAILROAD MEDICARE
FLD57723Medicare UPIN
FL64543XMedicare PIN