Provider Demographics
NPI:1396754479
Name:ZANKER, THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:
Last Name:ZANKER
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 1:315 WHITNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3715
Mailing Address - Country:US
Mailing Address - Phone:203-562-9444
Mailing Address - Fax:203-562-2360
Practice Address - Street 1:315 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3715
Practice Address - Country:US
Practice Address - Phone:203-562-9444
Practice Address - Fax:203-562-2360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-06
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT131422084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83896Medicare UPIN