Healthcare Provider Details

I. General information

NPI: 1306832480
Provider Name (Legal Business Name): REUBEN S MEZRICH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST ROOM N2E23
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

22 S GREENE ST ROOM N2E23
BALTIMORE MD
21201-1544
US

V. Phone/Fax

Practice location:
  • Phone: 410-328-3477
  • Fax: 410-328-5656
Mailing address:
  • Phone: 410-328-3477
  • Fax: 410-328-5656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0059309
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: