1659721991 NPI number — LAUREN STRADY ZIMMER D.O.

Table of content: LAUREN STRADY ZIMMER D.O. (NPI 1659721991)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659721991 NPI number — LAUREN STRADY ZIMMER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMER
Provider First Name:
LAUREN
Provider Middle Name:
STRADY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STRADY
Provider Other First Name:
LAUREN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659721991
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CADMUS LN STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EASTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21601-4094
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-822-8550
Provider Business Mailing Address Fax Number:
410-822-3741

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 CADMUS LN STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EASTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-822-8550
Provider Business Practice Location Address Fax Number:
410-822-3741
Provider Enumeration Date:
06/17/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  H0087890 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: O101285 . This is a "CONTROLLED SUBSTANCES ADMINISTRATION" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com