Healthcare Provider Details

I. General information

NPI: 1891701777
Provider Name (Legal Business Name): DAVID L ZIMMERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 SEYMOUR ST STE 200
HARTFORD CT
06106-5509
US

IV. Provider business mailing address

111 FOUNDERS PLZ STE. 400
EAST HARTFORD CT
06108-3212
US

V. Phone/Fax

Practice location:
  • Phone: 860-246-6589
  • Fax:
Mailing address:
  • Phone: 860-289-3375
  • Fax: 860-783-5733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number223515
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number045353
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: