Provider Demographics
NPI:1871564526
Name:ZYZNEWSKY, WLADIMIR A (MD)
Entity type:Individual
Prefix:
First Name:WLADIMIR
Middle Name:A
Last Name:ZYZNEWSKY
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 1:40 MEDICAL PARK
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-243-8822
Mailing Address - Fax:304-242-2682
Practice Address - Street 1:40 MEDICAL PARK
Practice Address - Street 2:SUITE 500
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-243-8822
Practice Address - Fax:304-242-2682
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV127722084N0400X
OH350485322084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0484935Medicaid
D49341Medicare UPIN
0495403Medicare ID - Type Unspecified