Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207ND0101X | MOHS-Micrographic Surgeon | 0101232840 | VA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | D0043824 | MD |
N | 207ND0900X | Dermatopathologist | 0101232840 | VA |
N | 207NS0135X | Procedural Dermatology | 0101232840 | VA |
NPI | 1720059736 |
---|---|
Provider Name | Dr. David S Mezebish |
First Address | Rockville, MD 20850-3385 |
Second Address | Rockville, MD 20850-3385 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0001 | BLUE CROSS BLUE SHIELD FEDERAL (01) | MD |
001734127 | MTST BCBS (01) | WV |
010165156 | (05) | VA |
180145 | ANTHEM BLUE CROSS BLUE SHIELD OF VIRGINIA (01) | VA |
3810002827 | (05) | WV |
61854810 | CAREFIRST BLUE CROSS BLUE SHIELD (01) | MD |
H65902 | (02) | VA |
P00252754 | RR MEDICARE (01) | VA |