Provider Demographics
NPI:1487768883
Name:ZWALD, FIONA (MD)
Entity type:Individual
Prefix:DR
First Name:FIONA
Middle Name:
Last Name:ZWALD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:FIONA
Other - Middle Name:MARY
Other - Last Name:O'REILLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:974 S ENOTA DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2429
Practice Address - Country:US
Practice Address - Phone:770-536-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0050418207N00000X
GA50418207ND0101X
CODR.0064920207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA588614Medicare UPIN
GA202I076586Medicare UPIN