Provider Demographics
NPI:1700890241
Name:ZINN, KENNETH L (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:L
Last Name:ZINN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-2599
Mailing Address - Country:US
Mailing Address - Phone:978-356-5522
Mailing Address - Fax:978-356-0218
Practice Address - Street 1:36 ESSEX RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-2599
Practice Address - Country:US
Practice Address - Phone:978-356-5522
Practice Address - Fax:978-356-0218
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2068788Medicaid
MA2068788Medicaid
D12022Medicare ID - Type Unspecified