Provider Demographics
NPI:1609801604
Name:ZIMM, EDWARD MATTHEW (DO)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:MATTHEW
Last Name:ZIMM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1429
Mailing Address - Country:US
Mailing Address - Phone:814-453-4575
Mailing Address - Fax:814-459-3885
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1427
Practice Address - Country:US
Practice Address - Phone:814-453-4575
Practice Address - Fax:814-459-3885
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014072207W00000X
MI5101015865174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4842782Medicaid
MI1852511335OtherBLUE CROSS & BLUE SHIELD
PAI49818Medicare UPIN
MIP10750003Medicare ID - Type Unspecified
MI4842782Medicaid