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NPI Code Detail

MEDICARE: MARINA MEZEY MD

MEDICARE:   MARINA  MEZEY  MD
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
1207Q00000XFamily Medicine Physician233658NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MD152276OTHERORLICENSE

General Provider Information

NPI Number : 1346234606
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARINA MEZEY MD
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number : 503-215-6494
Fax Number : 503-215-6644
Provider Business Practice Location Address
First Line : 1321 NE 99TH AVE
Second Line : SUITE 200
City : PORTLAND
State : OR
Zip : 97220-9436
Country : US
Telephone Number : 503-215-4250
Fax Number : 503-215-4255
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2005
Last Update Date : 12/29/2010

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Directions to “ MARINA MEZEY MD” Practice Location

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