Provider Demographics
NPI:1568420149
Name:ZIMMER, WENDY E (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:E
Last Name:ZIMMER
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 1:199 PARK CLUB LN STE 300
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-5269
Mailing Address - Country:US
Mailing Address - Phone:716-836-4646
Mailing Address - Fax:716-836-4696
Practice Address - Street 1:199 PARK CLUB LN STE 300
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-5269
Practice Address - Country:US
Practice Address - Phone:716-836-4646
Practice Address - Fax:716-836-4696
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1314802085R0202X
NY1988652085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00020544502OtherUNIVERA
P00080287OtherRR MEDICARE
0142860OtherGHI
197246FFOtherPREFERRED CARE
NY1988658WOtherWORKERS COMPENSATION
000523662009OtherBLUE SHIELD WNY
NY01575617Medicaid
5607163OtherINDEPENDENT HEALTH
P020198865OtherBLUE SHIELD ROCHESTER
00020544503OtherUNIVERA
4195244OtherGHI
P00051276OtherRR MEDICARE
000523662007OtherBLUE SHIELD WNY
040426001964OtherFIDELIS
P010198865OtherBLUE CHOICE
DD6457Medicare ID - Type Unspecified
197246FFOtherPREFERRED CARE
NYF83149Medicare UPIN
P010198865OtherBLUE CHOICE