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: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 S MAIN ST STE 305
MOUNT AIRY MD
21771-5374
US

IV. Provider business mailing address

1502 S MAIN ST STE 305
MOUNT AIRY MD
21771-5374
US

V. Phone/Fax

Practice location:
  • Phone: 301-703-8856
  • Fax: 301-703-8857
Mailing address:
  • Phone: 301-703-8856
  • Fax: 301-703-8857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberD45891
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberD45891
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: