Provider Demographics
NPI:1609136589
Name:ZIMMERMAN, MEGHAN SMALL (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGHAN
Middle Name:SMALL
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MEGHAN
Other - Middle Name:ANN
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:ONE MEDICAL CENTER DRIVE
Mailing Address - Street 2:PEDIATRIC CARDIOLOGY
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03756-0001
Mailing Address - Country:US
Mailing Address - Phone:603-653-9888
Mailing Address - Fax:
Practice Address - Street 1:ONE MEDICAL CENTER DRIVE
Practice Address - Street 2:PEDIATRIC CARDIOLOGY
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03756-0001
Practice Address - Country:US
Practice Address - Phone:603-653-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH200452080P0202X
DCMD044382208000000X
RIMD15066208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RIU400255409OtherNGS-MEDICARE
MA110104773AMedicaid
RI1609136589Medicaid