Healthcare Provider Details

I. General information

NPI: 1437149499
Provider Name (Legal Business Name): SUSAN ZIMMERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

331 OAK MANOR DR SUITE 102
GLEN BURNIE MD
21061-5508
US

IV. Provider business mailing address

2002 MEDICAL PKWY SUITE 430
ANNAPOLIS MD
21401-3046
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-2711
  • Fax: 410-269-1149
Mailing address:
  • Phone: 410-266-2711
  • Fax: 410-269-1149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberD40619
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: