Healthcare Provider Details

I. General information

NPI: 1750313078
Provider Name (Legal Business Name): ROSS R ZIMMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39TH AND MARKET ST 4 PHI
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3624 MARKET ST STE 560W UPHS OFFICE OF MEDICAL AFFAIRS
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9189
  • Fax: 215-243-4612
Mailing address:
  • Phone: 215-662-2286
  • Fax: 215-243-4612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberMD045305L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: