Provider Demographics
NPI:1174634836
Name:ZIMMER, WAYNE MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:MICHAEL
Last Name:ZIMMER
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 1:3126 WILMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1132
Mailing Address - Country:US
Mailing Address - Phone:724-656-5050
Mailing Address - Fax:724-658-2648
Practice Address - Street 1:3126 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1132
Practice Address - Country:US
Practice Address - Phone:724-656-5050
Practice Address - Fax:724-658-2648
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045449L207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAF95383Medicare UPIN
PA577257Medicare ID - Type Unspecified