Provider Demographics
NPI:1851456040
Name:ZIMMONS, PAUL STANLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STANLEY
Last Name:ZIMMONS
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 1:2101 E JEFFERSON ST
Mailing Address - Street 2:KAISER PERMANENTE MEDICARE ENROLLMENT
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-4908
Mailing Address - Country:US
Mailing Address - Phone:301-816-2424
Mailing Address - Fax:
Practice Address - Street 1:8261 WILLOW OAKS CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4512
Practice Address - Country:US
Practice Address - Phone:703-205-3600
Practice Address - Fax:703-205-3650
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2011-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010266552085R0202X
DCMD330802085R0202X
MDD00199842085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93044Medicare UPIN
011742M92Medicare ID - Type Unspecified