Provider Demographics
NPI:1639265614
Name:ZIMMERMAN, WILLIAM DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DALE
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LINCOLN ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-8264
Mailing Address - Country:US
Mailing Address - Phone:508-875-6124
Mailing Address - Fax:508-875-9349
Practice Address - Street 1:61 LINCOLN ST
Practice Address - Street 2:SUITE 207
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8264
Practice Address - Country:US
Practice Address - Phone:508-875-6124
Practice Address - Fax:508-875-9349
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0017056OtherNEIGHBORHOOD HEALTH
MAJ12201OtherBLUE CROSS BLUE SHEILD
MA19292OtherHARVARD PILGRIM MWMCIPA
MA28674OtherFALLON SELECT/DIRECT
MA3111181Medicaid
MA075573OtherTUFTS
MA1000067OtherUNIED HEALTHCARE
MA112521OtherUSHC
MA19543OtherHARVARD PILGRIM MILF IPA
MA23518OtherCHILDRENS MEDICAL SECURIT
MA3111181Medicaid
MA112521OtherUSHC