MEDICARE: DR. MAX SAM MAIZELS 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	207V00000X	Obstetrics & Gynecology Physician	0101027806	VA

General Provider Information

NPI Number	:	1124357561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAX SAM MAIZELS M.D.

Provider Business Mailing Address
First Line	:	328 OAK LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1656
Country	:	US
Telephone Number	:	804-282-0064
Fax Number	:	804-741-6056

Provider Business Practice Location Address
First Line	:	328 OAK LN
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1656
Country	:	US
Telephone Number	:	804-282-0064
Fax Number	:	804-741-6056

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

Provider Enumeration Date	:	12/14/2009
Last Update Date	:	12/14/2009

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