Healthcare Provider Details

I. General information

NPI: 1033168570
Provider Name (Legal Business Name): VALERIA H ZINCKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4480 KING ST ALEXANDRIA HEALTH DEPARTMENT
ALEXANDRIA VA
22302-1300
US

IV. Provider business mailing address

4480 KING ST ALEXANDRIA HEALTH DEPARTMENT
ALEXANDRIA VA
22302-1300
US

V. Phone/Fax

Practice location:
  • Phone: 703-838-4400
  • Fax: 703-838-4037
Mailing address:
  • Phone: 703-838-4400
  • Fax: 703-838-4037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101035889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: