MEDICARE: DR. SCOTT DAVID ZIMMER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	240307	MA

General Provider Information

NPI Number	:	1447487087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT DAVID ZIMMER MD

Provider Business Mailing Address
First Line	:	35 E CONCORD ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02118-1983
Country	:	US
Telephone Number	:	978-509-9504
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 DEACONESS RD
Second Line	:	WEST CAMPUS/CLINICAL CENTER 470
City	:	BOSTON
State	:	MA
Zip	:	02115-6007
Country	:	US
Telephone Number	:	617-754-2713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2009
Last Update Date	:	04/11/2011

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