Provider Demographics
NPI:1497860704
Name:ZINCKE, JAN PAUL
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:PAUL
Last Name:ZINCKE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 820
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-654-2521
Mailing Address - Fax:301-654-2986
Practice Address - Street 1:4831 TELSA DR
Practice Address - Street 2:SUITE F
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-4323
Practice Address - Country:US
Practice Address - Phone:240-737-0080
Practice Address - Fax:301-262-7530
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD034750174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD034750OtherMEDICAL LICENSE
DCMD034750OtherMEDICAL LICENSE