Provider Demographics
NPI:1700082583
Name:ZIMMER, EDWARD F (MA)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:F
Last Name:ZIMMER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 HOOPER CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NC
Mailing Address - Zip Code:27278-8993
Mailing Address - Country:US
Mailing Address - Phone:919-732-4432
Mailing Address - Fax:
Practice Address - Street 1:2601 HOOPER CT
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-8993
Practice Address - Country:US
Practice Address - Phone:919-732-4432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2241103T00000X, 103TC0700X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6107035Medicaid
NC04580OtherBCBS PROVIDER NO.
NC149737OtherVALUE OPTIONS PROVIDER NO