Provider Demographics
NPI:1043437924
Name:ZIMMERMAN, MICHAEL RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RAYMOND
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:732 WEADLEY RD
Mailing Address - Street 2:
Mailing Address - City:RADNOR
Mailing Address - State:PA
Mailing Address - Zip Code:19087-2851
Mailing Address - Country:US
Mailing Address - Phone:610-964-8455
Mailing Address - Fax:
Practice Address - Street 1:401 COMMERCE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-2714
Practice Address - Country:US
Practice Address - Phone:215-643-9960
Practice Address - Fax:215-643-9963
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012121E207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology