Provider Demographics
NPI:1811991219
Name:ZINICOLA, DANIEL FRANCIS (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:FRANCIS
Last Name:ZINICOLA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NC
Mailing Address - Zip Code:28457
Mailing Address - Country:US
Mailing Address - Phone:910-675-8089
Mailing Address - Fax:910-675-8103
Practice Address - Street 1:27 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NC
Practice Address - Zip Code:28457-7871
Practice Address - Country:US
Practice Address - Phone:910-675-8089
Practice Address - Fax:910-675-8103
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC32605207QG0300X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC211831FOtherMEDICARE
NC7989945Medicaid
NC89945OtherNC BLUE CROSS BLUE SHIELD
NC7989945Medicaid