Healthcare Provider Details

I. General information

NPI: 1962430348
Provider Name (Legal Business Name): BRIAN W ZIMMER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

IV. Provider business mailing address

121 FREEPORT RD STE 200
BLAWNOX PA
15238-3485
US

V. Phone/Fax

Practice location:
  • Phone: 412-683-4550
  • Fax: 412-246-4567
Mailing address:
  • Phone: 412-683-4550
  • Fax: 412-683-4550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS012702
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: