1497860704 NPI number — DR. JAN PAUL ZINCKE

Table of content: (NPI 1316392830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497860704 NPI number — DR. JAN PAUL ZINCKE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZINCKE
Provider First Name:
JAN
Provider Middle Name:
PAUL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497860704
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5530 WISCONSIN AVE
Provider Second Line Business Mailing Address:
SUITE 820
Provider Business Mailing Address City Name:
CHEVY CHASE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20815-4404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-654-2521
Provider Business Mailing Address Fax Number:
301-654-2986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4831 TELSA DR
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-4323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-737-0080
Provider Business Practice Location Address Fax Number:
301-262-7530
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD034750 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MD034750 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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