Healthcare Provider Details

I. General information

NPI: 1720059736
Provider Name (Legal Business Name): DAVID S MEZEBISH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 THOMAS JOHNSON DR STE H
FREDERICK MD
21702-4895
US

IV. Provider business mailing address

75 THOMAS JOHNSON DR STE H
FREDERICK MD
21702-4895
US

V. Phone/Fax

Practice location:
  • Phone: 301-668-9850
  • Fax: 301-668-9853
Mailing address:
  • Phone: 301-668-9850
  • Fax: 301-668-9853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number0101232840
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number0101232840
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number0101232840
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberD0043824
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number0101232840
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: