Provider Demographics
NPI:1629105085
Name:ZIMM, RICHARD C (PA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:ZIMM
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 STATE ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507
Mailing Address - Country:US
Mailing Address - Phone:814-456-6022
Mailing Address - Fax:814-455-4731
Practice Address - Street 1:300 STATE ST
Practice Address - Street 2:SUITE 205
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507
Practice Address - Country:US
Practice Address - Phone:814-456-6022
Practice Address - Fax:814-455-4731
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052248363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y8753OtherBCBS
TX8L0108Medicare PIN