Basic Information
Provider Information | |||||||||
NPI: | 1407047996 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ZIMMERMAN | ||||||||
FirstName: | CHRISTINA | ||||||||
MiddleName: | MARIE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BAKER | ||||||||
OtherFirstName: | CHRISTINA | ||||||||
OtherMiddleName: | MARIE | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | D.O. | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6 E CHESTNUT ST | ||||||||
Address2: |   | ||||||||
City: | AUGUSTA | ||||||||
State: | ME | ||||||||
PostalCode: | 043305717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2078615000 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6 E CHESTNUT ST | ||||||||
Address2: |   | ||||||||
City: | AUGUSTA | ||||||||
State: | ME | ||||||||
PostalCode: | 043305717 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2078615000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/08/2007 | ||||||||
LastUpdateDate: | 11/13/2014 | ||||||||
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 | 207Q00000X | T0767 | ME | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | N0622 | TX | N |   | Allopathic & Osteopathic Physicians | Family Medicine |   | 207Q00000X | DO2348 | ME | Y |   | Allopathic & Osteopathic Physicians | Family Medicine |   |
No ID Information.