Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 216753 | MA |
N | 2084N0402X | Child Neurologist | 216753 | MA |
NPI | 1184682577 |
---|---|
Provider Name | Andrew W Zimmerman |
First Address | Boston, MA 02241-5348 |
Second Address | Worcester, MA 01655-0002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2006 |
Last Update Date | 25/05/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
110033314A | (05) | MA |
S400104406 | MEDICARE (01) | MA |