Provider Demographics
NPI:1053368407
Name:ZIMMER, GARY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:DAVID
Last Name:ZIMMER
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 1:300 THORNBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-1637
Mailing Address - Country:US
Mailing Address - Phone:610-517-0530
Mailing Address - Fax:
Practice Address - Street 1:2500 BERNVILLE RD
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19605-9453
Practice Address - Country:US
Practice Address - Phone:215-710-5900
Practice Address - Fax:866-789-6895
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09331300207P00000X
RIMD14110207P00000X
NY274761207P00000X
PAMD427612207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H33361Medicare UPIN