Provider Demographics
NPI:1407235112
Name:ZIMMERMAN, KRISTINA M (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-851-2521
Mailing Address - Fax:717-851-3535
Practice Address - Street 1:2003 SPRINGWOOD RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-4836
Practice Address - Country:US
Practice Address - Phone:717-851-2521
Practice Address - Fax:717-260-3330
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY292527207Q00000X
PAMD464158207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05247250Medicaid