Provider Demographics
NPI:1437149499
Name:ZIMMERMAN, SUSAN (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
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 1:2002 MEDICAL PKWY
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3046
Mailing Address - Country:US
Mailing Address - Phone:410-266-2711
Mailing Address - Fax:410-269-1149
Practice Address - Street 1:331 OAK MANOR DR
Practice Address - Street 2:SUITE 102
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5508
Practice Address - Country:US
Practice Address - Phone:410-266-2711
Practice Address - Fax:410-269-1149
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD406192081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD313437OtherMAMSI HEALTH PLANS
DCC4750002OtherBLUE SHIELD DC
MD52137201OtherBLUE SHIELD MD
MD4223508OtherAETNA
DCC4750002OtherBLUE SHIELD DC
MDKQ86MP25Medicare ID - Type UnspecifiedMEDICARE