Provider Demographics
NPI:1932236387
Name:ZIMMERMAN, LORI ALLISON (MD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:ALLISON
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 LONGWOOD AVENUE, HUNN G
Mailing Address - Street 2:BOSTON CHILDREN'S HOSPITAL
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:617-355-6058
Mailing Address - Fax:617-730-0496
Practice Address - Street 1:300 LONGWOOD AVENUE
Practice Address - Street 2:HUNN G
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:617-355-6058
Practice Address - Fax:617-730-0496
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAL-228692208000000X
MA2389172080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics