Provider Demographics
NPI:1891820908
Name:ZIMNITZKY, BRIAN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MICHAEL
Last Name:ZIMNITZKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:716 GIDDINGS AVE STE 33
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1408
Mailing Address - Country:US
Mailing Address - Phone:443-603-1344
Mailing Address - Fax:410-510-1588
Practice Address - Street 1:716 GIDDINGS AVE STE 33
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1408
Practice Address - Country:US
Practice Address - Phone:443-603-1344
Practice Address - Fax:410-510-1588
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00572982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G47415Medicare UPIN
00G822650Medicare ID - Type Unspecified