Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | D0031874 | MD |
NPI | 1003801424 |
---|---|
Provider Name | Edward Zimmerman |
First Address | Baltimore, MD 21208-6391 |
Second Address | Baltimore, MD 21208-6391 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2005 |
Last Update Date | 27/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D76338 | (02) | MD |