Provider Demographics
NPI:1215001425
Name:MELZER, MARK LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:MELZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9199 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 100B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-4520
Mailing Address - Country:US
Mailing Address - Phone:410-363-2002
Mailing Address - Fax:410-363-8977
Practice Address - Street 1:9199 REISTERSTOWN RD
Practice Address - Street 2:SUITE 100B
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-4520
Practice Address - Country:US
Practice Address - Phone:410-363-2002
Practice Address - Fax:410-363-8977
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033162208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics