Provider Demographics
NPI:1629071931
Name:ZINNAMOSCA, JOHN B (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:ZINNAMOSCA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 WATER ST
Mailing Address - Street 2:
Mailing Address - City:MEADVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16335-3445
Mailing Address - Country:US
Mailing Address - Phone:814-337-2273
Mailing Address - Fax:814-337-8091
Practice Address - Street 1:1009 WATER ST
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3445
Practice Address - Country:US
Practice Address - Phone:814-337-2273
Practice Address - Fax:814-337-8091
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS002926L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006174030005Medicaid
PA0006174030005Medicaid