Provider Demographics
NPI:1114958071
Name:ZIMMERMAN, AMY A (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:A
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 YORK RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6220
Mailing Address - Country:US
Mailing Address - Phone:410-821-9490
Mailing Address - Fax:410-821-9495
Practice Address - Street 1:8201 PHILADELPHIA RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2832
Practice Address - Country:US
Practice Address - Phone:410-866-2022
Practice Address - Fax:410-866-2031
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2012-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCR589 0003OtherCAREFIRST
GADC6317 P00180913OtherRAILROAD MEDICARE
MD407221900 596071100Medicaid
MDKBI9KA 53238805OtherCAREFIRST
MD534M 534M831FMedicare PIN
MD407221900 596071100Medicaid