Provider Demographics
NPI:1972523173
Name:ZIMMERMAN, TERESA N (MD)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:N
Last Name:ZIMMERMAN
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 1:24701 EUCLID AVENUE
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44117
Mailing Address - Country:US
Mailing Address - Phone:216-383-6612
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0791902080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH745989OtherBUCKEYE
OH364167OtherWELLCARE
OH4352478OtherAETNA
PA1021650580001OtherPA MEDICAID
OH2253396Medicaid
OH000000526178OtherANTHEM
OH000000204226OtherANTHEM
OH000000221295OtherUNISON
2253396OtherBCMH
OHZI4055473Medicare PIN
PA1021650580001OtherPA MEDICAID
OH4352478OtherAETNA
OH364167OtherWELLCARE
OHZI4055474Medicare PIN