Healthcare Provider Details

I. General information

NPI: 1770642944
Provider Name (Legal Business Name): ELENITA J QUIZON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7501 LIBERTY ROAD SUITE C
BALTIMORE MD
21207
US

IV. Provider business mailing address

721 HUNTER WAY
BALTIMORE MD
21228
US

V. Phone/Fax

Practice location:
  • Phone: 410-298-3711
  • Fax: 410-298-3382
Mailing address:
  • Phone: 410-747-2913
  • Fax: 410-298-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD21821
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: