Provider Demographics
NPI:1417954595
Name:ZIMAROWSKI, MARYJANE
Entity Type:Individual
Prefix:DR
First Name:MARYJANE
Middle Name:
Last Name:ZIMAROWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4853
Mailing Address - Country:US
Mailing Address - Phone:781-255-0555
Mailing Address - Fax:781-255-0594
Practice Address - Street 1:640 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4853
Practice Address - Country:US
Practice Address - Phone:781-255-0555
Practice Address - Fax:781-255-0594
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA74509174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3082181Medicaid
MA3082181Medicaid
MAJ11536Medicare ID - Type Unspecified