Healthcare Provider Details

I. General information

NPI: 1447438593
Provider Name (Legal Business Name): KENDALL REID ZMIEWSKY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 APPLECROSS ROAD
SOUTHERN PINES NC
28387
US

IV. Provider business mailing address

PO BOX 749
SOUTHERN PINES NC
28388-0749
US

V. Phone/Fax

Practice location:
  • Phone: 910-692-7928
  • Fax: 910-692-5962
Mailing address:
  • Phone: 910-692-7928
  • Fax: 910-692-5962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number130221
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: