=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801308333
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN JESSICA ZIMMER PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2017
-----------------------------------------------------
Last Update Date | 04/08/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 590 S 5TH AVE
-----------------------------------------------------
City | LEBANON
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17042-9195
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-274-0421
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2901 JOLLY RD
-----------------------------------------------------
City | PLYMOUTH MEETING
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19462-2324
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-272-8221
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | MA059513
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------