Provider Demographics
NPI:1215991179
Name:ZIMRIN, ANN BUTLER (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:BUTLER
Last Name:ZIMRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 62602
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2602
Mailing Address - Country:US
Mailing Address - Phone:419-328-2594
Mailing Address - Fax:410-328-6896
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:419-328-2594
Practice Address - Fax:410-328-6896
Is Sole Proprietor?:No
Enumeration Date:2006-04-16
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39639207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS053-0042OtherBLUE CHOICE-REGIONAL
MD442100100Medicaid
MD604401-02 & 03OtherBC/BS
MD830008237Medicare PIN
MD604401-02 & 03OtherBC/BS
MD442100100Medicaid