Healthcare Provider Details

I. General information

NPI: 1700890241
Provider Name (Legal Business Name): KENNETH L ZINN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 11/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 ESSEX RD
IPSWICH MA
01938-2599
US

IV. Provider business mailing address

36 ESSEX RD
IPSWICH MA
01938-2599
US

V. Phone/Fax

Practice location:
  • Phone: 978-356-5522
  • Fax: 978-356-0218
Mailing address:
  • Phone: 978-356-5522
  • Fax: 978-356-0218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number40320
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: