Provider Demographics
NPI:1497709398
Name:ZINK, THERESE M (MD)
Entity Type:Individual
Prefix:
First Name:THERESE
Middle Name:M
Last Name:ZINK
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 1:375 ALLENS AVE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02905-5010
Mailing Address - Country:US
Mailing Address - Phone:401-444-0400
Mailing Address - Fax:401-444-0468
Practice Address - Street 1:355 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02905
Practice Address - Country:US
Practice Address - Phone:401-444-0570
Practice Address - Fax:401-444-0427
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-073929207Q00000X
MN30207207QA0000X, 207QA0505X
RIMD16139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0120279OtherMEDICA PRIMARY
MN587T6ZIOtherBCBS
116273OtherUCARE
MN664382500Medicaid
A030OtherCHAMPUS-TRICARE
HP11770OtherHEALTHPARTNERS
IA0598466Medicaid
1040859OtherPREFERRED ONE
01-20279OtherMEDICA CHOICE
OH2049367Medicaid
2214946OtherPPO
WI34686600Medicaid