Provider Demographics
NPI:1750313078
Name:ZIMMER, ROSS R (MD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:R
Last Name:ZIMMER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3624 MARKET ST
Mailing Address - Street 2:STE 560W UPHS OFFICE OF MEDICAL AFFAIRS
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-2286
Mailing Address - Fax:215-243-4612
Practice Address - Street 1:39TH AND MARKET ST
Practice Address - Street 2:4 PHI
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-9189
Practice Address - Fax:215-243-4612
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-08-29
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Provider Licenses
StateLicense IDTaxonomies
PAMD045305L207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014152510006Medicaid
PA003776Medicare ID - Type Unspecified
PA0014152510006Medicaid