MEDICARE: MR. LEONARD J. ZIMMER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024172013	VA

General Provider Information

NPI Number	:	1740240001
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LEONARD J. ZIMMER FNP

Provider Business Mailing Address
First Line	:	11350 MCCORMICK ROAD
Second Line	:	EXECUTIVE PLAZA 1, SUITE 501
City	:	HUNT VALLEY
State	:	MD
Zip	:	21031
Country	:	US
Telephone Number	:	703-914-8000
Fax Number	:	703-642-1876

Provider Business Practice Location Address
First Line	:	1630 WILKES RIDGE PKWY STE 203
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-7460
Country	:	US
Telephone Number	:	703-914-8000
Fax Number	:	703-642-1876

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/11/2019

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