Provider Demographics
NPI:1972601409
Name:ZIMMERMANN, GREGORY S (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:S
Last Name:ZIMMERMANN
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 1:322 E ANTIETAM ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-5794
Mailing Address - Country:US
Mailing Address - Phone:301-739-6144
Mailing Address - Fax:301-739-6163
Practice Address - Street 1:322 E ANTIETAM ST
Practice Address - Street 2:SUITE 106
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5794
Practice Address - Country:US
Practice Address - Phone:301-739-6144
Practice Address - Fax:301-739-6163
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD560822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD079104100Medicaid
MDKN7702JJMedicare PIN
MDH54701JJMedicare PIN
300115042Medicare PIN
MD079104100Medicaid
300117986Medicare PIN