Healthcare Provider Details

I. General information

NPI: 1609900109
Provider Name (Legal Business Name): THOMAS MICHAEL ZIZIC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD RMB SUITE 509
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

47 LOVETON CIR STE R
SPARKS MD
21152-9216
US

V. Phone/Fax

Practice location:
  • Phone: 410-340-7819
  • Fax:
Mailing address:
  • Phone: 410-472-7203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberD0012471
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: