Provider Demographics
NPI:1669408936
Name:ZWALLY, HENRY JAY II (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:JAY
Last Name:ZWALLY
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:H.
Other - Middle Name:
Other - Last Name:ZWALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:20010 CENTURY BLVD.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874
Mailing Address - Country:US
Mailing Address - Phone:240-780-7899
Mailing Address - Fax:240-780-7899
Practice Address - Street 1:7116 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-2904
Practice Address - Country:US
Practice Address - Phone:443-577-0277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0042684207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD064940600Medicaid
DC001078D14Medicare PIN