Provider Demographics
NPI:1487633129
Name:ZINSSER, KENDALL (MD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:
Last Name:ZINSSER
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 1:2 MERIDIAN BLVD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-3202
Mailing Address - Country:US
Mailing Address - Phone:610-568-1380
Mailing Address - Fax:610-372-3735
Practice Address - Street 1:4TH AND WALNUT ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:610-568-1380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD021537E207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0011368270001Medicaid
PAB41935Medicare UPIN
PA0011368270001Medicaid