Provider Demographics
NPI:1346217338
Name:BELIZAN, LUCIANO ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:LUCIANO
Middle Name:ROBERTO
Last Name:BELIZAN
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 1:5801 NICHOLSON LN
Mailing Address - Street 2:APT. 1232
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-5719
Mailing Address - Country:US
Mailing Address - Phone:301-984-1941
Mailing Address - Fax:
Practice Address - Street 1:9715 MEDICAL CENTER DR
Practice Address - Street 2:STE. 530
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3320
Practice Address - Country:US
Practice Address - Phone:301-279-7622
Practice Address - Fax:301-279-7624
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023752174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD46277255OtherMULTIPLAN PROVIDER #
MD908253OtherFIRST HEALTH PROVIDER #
MD2127615OtherOPTIMUM CHOICE PROVIDER #
MD3612200OtherAETNA PROVIDER #
MD2127615OtherMDIPA PROVIDER #
MD2127615OtherMAMSI PROVIDER #
MD675528OtherNCPPO PROVIDER #
MD2127615OtherALLIANCE PROVIDER #
DCJ9900001OtherBLUE SHIELD PROVIDER #
G01714L01Medicare ID - Type UnspecifiedMEMBER NUMBER
MD2127615OtherMAMSI PROVIDER #