Provider Demographics
NPI:1730270133
Name:ZINNER, TANYA E (MD)
Entity type:Individual
Prefix:DR
First Name:TANYA
Middle Name:E
Last Name:ZINNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 LAKE BOONE TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6521
Mailing Address - Country:US
Mailing Address - Phone:919-784-6675
Mailing Address - Fax:919-784-6673
Practice Address - Street 1:4210 LAKE BOONE TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6521
Practice Address - Country:US
Practice Address - Phone:919-784-6675
Practice Address - Fax:919-784-6673
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200000161208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127R7Medicaid
NC89127R7Medicaid
NC2281064AMedicare ID - Type Unspecified