Provider Demographics
NPI:1154397156
Name:ZELENAK, JAMES KENNETH (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:KENNETH
Last Name:ZELENAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 GLENSIDE DR
Mailing Address - Street 2:STE 105
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3769
Mailing Address - Country:US
Mailing Address - Phone:804-288-0399
Mailing Address - Fax:804-285-0088
Practice Address - Street 1:1800 GLENSIDE DR STE 101
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3769
Practice Address - Country:US
Practice Address - Phone:804-288-3001
Practice Address - Fax:804-673-5614
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233601207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010070333Medicaid
VA1154397156Medicaid
VAP00102673OtherRAILROAD MEDICARE
VA139251OtherANTHEM
VA1154397156Medicaid
VAP00102673OtherRAILROAD MEDICARE
VA004094C00Medicare PIN