Provider Demographics
NPI:1003939372
Name:CHAZBRO INC
Entity Type:Organization
Organization Name:CHAZBRO INC
Other - Org Name:ZIMMERMANN'S SHOES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:CPED
Authorized Official - Phone:410-544-1302
Mailing Address - Street 1:405 RITCHIE HWY
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-2910
Mailing Address - Country:US
Mailing Address - Phone:410-544-1302
Mailing Address - Fax:410-544-3738
Practice Address - Street 1:405 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-2910
Practice Address - Country:US
Practice Address - Phone:410-544-1302
Practice Address - Fax:410-544-3738
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD158778101Medicaid
MD0753950002Medicare NSC