Provider Demographics
NPI:1992762884
Name:ZIMMERMAN, JOHN F (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STAFFORD ST
Mailing Address - Street 2:SUITE 154
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01104-4110
Mailing Address - Country:US
Mailing Address - Phone:413-781-5735
Mailing Address - Fax:413-781-5735
Practice Address - Street 1:300 STAFFORD ST
Practice Address - Street 2:SUITE 154
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104-4110
Practice Address - Country:US
Practice Address - Phone:413-781-5735
Practice Address - Fax:413-781-5735
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA54820207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3072738Medicaid
MAJ06489Medicare ID - Type Unspecified
MA3072738Medicaid
MAB74868Medicare UPIN