Provider Demographics
NPI:1306832480
Name:MEZRICH, REUBEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:S
Last Name:MEZRICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 S GREENE ST
Mailing Address - Street 2:ROOM N2E23
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-1544
Mailing Address - Country:US
Mailing Address - Phone:410-328-3477
Mailing Address - Fax:410-328-5656
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:ROOM N2E23
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-3477
Practice Address - Fax:410-328-5656
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00593092085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC38110058OtherCAREFIRST BCBS
MDKC46SHOtherCAREFIRST BCBS
MD110800000 376500800Medicaid
MDE13281Medicare UPIN
DC38110058OtherCAREFIRST BCBS
MD545L F556Medicare PIN
MDH380E629Medicare PIN