Healthcare Provider Details

I. General information

NPI: 1285662080
Provider Name (Legal Business Name): INGRID ZIMMER-GALLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: INGRID ZIMMER

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 02/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

PO BOX 64481
BALTIMORE MD
21264-4481
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5080
  • Fax:
Mailing address:
  • Phone: 410-955-3518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD45891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: