Basic Information
Provider Information | |||||||||
NPI: | 1972523173 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZIMMERMAN | ||||||||
FirstName: | TERESA | ||||||||
MiddleName: | N | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 24701 EUCLID AVENUE | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | EUCLID | ||||||||
State: | OH | ||||||||
PostalCode: | 44117 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2163836612 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 11100 EUCLID AVENUE | ||||||||
Address2: |   | ||||||||
City: | CLEVELAND | ||||||||
State: | OH | ||||||||
PostalCode: | 44106 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2168447700 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/20/2006 | ||||||||
LastUpdateDate: | 08/18/2011 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0205X | 35-079190 | OH | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Endocrinology |
ID Information
ID | Type | State | Issuer | Description | 745989 | 01 | OH | BUCKEYE | OTHER | 364167 | 01 | OH | WELLCARE | OTHER | 4352478 | 01 | OH | AETNA | OTHER | 1021650580001 | 01 | PA | PA MEDICAID | OTHER | 2253396 | 05 | OH |   | MEDICAID | 000000526178 | 01 | OH | ANTHEM | OTHER | 000000204226 | 01 | OH | ANTHEM | OTHER | 000000221295 | 01 | OH | UNISON | OTHER | 2253396 | 01 |   | BCMH | OTHER |