Provider Demographics
NPI:1073533147
Name:ZINSMEISTER, BRIAN JOHN (DPM)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JOHN
Last Name:ZINSMEISTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 BEDFORD STREET
Mailing Address - Street 2:SUITE 31
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4646
Mailing Address - Country:US
Mailing Address - Phone:781-862-3953
Mailing Address - Fax:781-862-4306
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 31
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:781-862-3953
Practice Address - Fax:781-862-4306
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1809213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0361577Medicaid
MA0361577Medicaid
MAY70818Medicare ID - Type Unspecified