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Stefan Loy Zimmerman

Radiology

Allopathic & Osteopathic Physicians

600 N Wolfe St, Department Of Radiology, Baltimore, MD 21287-0005

PECOS Enrollment

This provider is enrolled in PECOS as STEFAN ZIMMERMAN.

Based on the most recent information from CMS, provider Stefan Loy Zimmerman is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 5 days ago.

Profile Details

Provider ID
1184773004
Provider Type
Individual
Full Name
Zimmerman, Stefan Loy
Title
Dr.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
1/9/2007
Last Updated
10/27/2018

Contact Information

Practice Location

600 N Wolfe St, Department Of Radiology, Baltimore, MD 21287-0005

(410) 955-6500

Unlisted Fax

Mailing Location

9910 Franklin Square Dr Ste 2110, Baltimore, MD 21236-4902

(410) 933-6423

(410) 933-1390

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License D0069425 Maryland
Code 2085R0202X	Description Radiology Allopathic & Osteopathic Physicians	License MD437001 Pennsylvania

Provider Identifiers

ID	Description	Issuer
ID 417756800	Description Medicaid	Issuer Unlisted Maryland

Stefan Loy Zimmerman

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

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Mollura, Daniel Joseph

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Weiss, Clifford Raabe

Esterson, Yonah Baruch