Healthcare Provider Details

I. General information

NPI: 1497860704
Provider Name (Legal Business Name): DR. JAN PAUL ZINCKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 04/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4831 TELSA DR SUITE F
BOWIE MD
20715-4323
US

IV. Provider business mailing address

5530 WISCONSIN AVE SUITE 820
CHEVY CHASE MD
20815-4404
US

V. Phone/Fax

Practice location:
  • Phone: 240-737-0080
  • Fax: 301-262-7530
Mailing address:
  • Phone: 301-654-2521
  • Fax: 301-654-2986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD034750
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: