Provider Demographics
NPI:1174593495
Name:COX, HEATHER ZINZELLA (MD)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ZINZELLA
Last Name:COX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:M
Other - Last Name:ZINZELLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:30 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807-1206
Mailing Address - Country:US
Mailing Address - Phone:302-893-1281
Mailing Address - Fax:
Practice Address - Street 1:30 HOLLY LN
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807-1206
Practice Address - Country:US
Practice Address - Phone:302-893-1281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0006143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000015904Medicaid
DEH73518Medicare UPIN
DEG02723I21Medicare PIN
DEH73518Medicare UPIN