Healthcare Provider Details

I. General information

NPI: 1285876011
Provider Name (Legal Business Name): ZACHARY ALLEN ZINN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 STADIUM DR STE 3
MORGANTOWN WV
26506-7900
US

IV. Provider business mailing address

217 STONE GATE CIR
MORGANTOWN WV
26505-1803
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4865
  • Fax:
Mailing address:
  • Phone: 412-721-9593
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number24544
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: