Provider Demographics
NPI:1871704221
Name:ZUBKUS, DMITRIY (MD)
Entity type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:ZUBKUS
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 1:1222 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1215
Mailing Address - Country:US
Mailing Address - Phone:717-851-2465
Mailing Address - Fax:321-843-6432
Practice Address - Street 1:1222 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1215
Practice Address - Country:US
Practice Address - Phone:717-851-2465
Practice Address - Fax:321-843-6432
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101272454207RC0200X
PAMD434242207RC0200X, 207RP1001X
FLME152827207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1576333OtherGATEWAY-WMG
PA102139432Medicaid
PA2053372OtherHIGHMARK BLUE SHIELD
PA20087305OtherAMERIHEALTH MERCY-WMG
PA271779OtherUNISON-WMG
MD937943OtherCAREFIRST MD BCBS
PA128423Medicare PIN
PA102139432Medicaid