Provider Demographics
NPI:1770626335
Name:ZINKAWICH, JOAN P (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:P
Last Name:ZINKAWICH
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 1:79 GREELEY ST
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:NH
Mailing Address - Zip Code:03051-3513
Mailing Address - Country:US
Mailing Address - Phone:603-880-4972
Mailing Address - Fax:
Practice Address - Street 1:156 HARVEY RD
Practice Address - Street 2:
Practice Address - City:LONDONDERRY
Practice Address - State:NH
Practice Address - Zip Code:03053-7449
Practice Address - Country:US
Practice Address - Phone:603-644-3330
Practice Address - Fax:603-644-3332
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY184602-1207R00000X
NH13732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30206803Medicaid
NHP00717406OtherRAILROAD MEDICARE
NHP00717406OtherRAILROAD MEDICARE