Healthcare Provider Details

I. General information

NPI: 1992152789
Provider Name (Legal Business Name): YEVGENIY ZENCHENKO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2016
Last Update Date: 03/28/2026
Certification Date: 03/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUNNINGHAM LN
CLAYTON NC
27527-3923
US

IV. Provider business mailing address

CARL R. DARNALL ARMY MEDICAL CENTER, 36065 SANTE FE AVE
FORT HOOD TX
76544
US

V. Phone/Fax

Practice location:
  • Phone: 919-359-6016
  • Fax: 919-359-6017
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2022-02718
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: