MEDICARE: DR. DAVID S MEZEBISH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ND0900X	Dermatopathology Physician	0101232840	VA
2	207NI0002X	Clinical & Laboratory Dermatological Immunology Physician	0101232840	VA
3	207NS0135X	Procedural Dermatology Physician	0101232840	VA
4	207ND0101X	MOHS-Micrographic Surgery Physician	D0043824	MD
5	207ND0101X	MOHS-Micrographic Surgery Physician	0101232840	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P00252754	OTHER	VA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	001734127	OTHER	WV	MTST BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	180145	OTHER	VA	ANTHEM BLUE CROSS BLUE SHIELD OF VIRGINIA
5	61854810	OTHER	MD	CAREFIRST BLUE CROSS BLUE SHIELD
7	0001	OTHER	MD	BLUE CROSS BLUE SHIELD FEDERAL

General Provider Information

NPI Number	:	1720059736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S MEZEBISH M.D.

Provider Business Mailing Address
First Line	:	75 THOMAS JOHNSON DR STE H
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4895
Country	:	US
Telephone Number	:	301-668-9850
Fax Number	:	301-668-9853

Provider Business Practice Location Address
First Line	:	75 THOMAS JOHNSON DR STE H
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-4895
Country	:	US
Telephone Number	:	301-668-9850
Fax Number	:	301-668-9853

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2006
Last Update Date	:	01/25/2023

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Directions to “ DR. DAVID S MEZEBISH M.D.” Practice Location

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