Provider Demographics
NPI:1750494753
Name:ZIMMERN, SAMUEL H (MD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:H
Last Name:ZIMMERN
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1021 MOREHEAD MEDICAL DR
Practice Address - Street 2:STE A
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2990
Practice Address - Country:US
Practice Address - Phone:980-442-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26171207R00000X, 207RC0001X, 207RC0000X, 207RC0001X, 207RC0000X
SC14428207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8989923Medicaid
NC1750494753Medicaid
NC89923OtherBCBS
P00202484OtherRAILROAD MEDICARE
SCN89923Medicaid
P00202484OtherRAILROAD MEDICARE
NCNC9412BMedicare PIN
NC89923OtherBCBS
NC8989923Medicaid
NC211817NMedicare PIN
SCC873578186Medicare PIN