Healthcare Provider Details

I. General information

NPI: 1366616955
Provider Name (Legal Business Name): ZINABU MAXWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2008
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 JACKSON ST
LOWELL MA
01852-2103
US

IV. Provider business mailing address

135 JACKSON ST
LOWELL MA
01852-2103
US

V. Phone/Fax

Practice location:
  • Phone: 978-441-1700
  • Fax: 978-454-1681
Mailing address:
  • Phone: 978-937-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301091560
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301091560
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number246820
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: