Provider Demographics
NPI:1659721991
Name:ZIMMER, LAUREN STRADY (DO)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:STRADY
Last Name:ZIMMER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:STRADY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 CADMUS LN STE 210
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4094
Mailing Address - Country:US
Mailing Address - Phone:410-822-8550
Mailing Address - Fax:410-822-3741
Practice Address - Street 1:500 CADMUS LN STE 210
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-822-8550
Practice Address - Fax:410-822-3741
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0087890208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDO101285OtherCONTROLLED SUBSTANCES ADMINISTRATION
MDO101285OtherCONTROLLED SUBSTANCES ADMINISTRATION