Provider Demographics
NPI:1265484380
Name:MAXIMO, ZOSIMO (MD)
Entity type:Individual
Prefix:
First Name:ZOSIMO
Middle Name:
Last Name:MAXIMO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9614
Mailing Address - Country:US
Mailing Address - Phone:740-439-0733
Mailing Address - Fax:740-439-8996
Practice Address - Street 1:1200 CLARK ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9611
Practice Address - Country:US
Practice Address - Phone:740-439-0733
Practice Address - Fax:740-439-8996
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35034200207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0218982Medicaid
OH0218982Medicaid
OH0380321Medicare ID - Type Unspecified