Provider Demographics
NPI:1558414284
Name:CHYZUS, PAUL JOHN
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:JOHN
Last Name:CHYZUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 NORTH POINT BLVD
Mailing Address - Street 2:SUITE 603
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224
Mailing Address - Country:US
Mailing Address - Phone:410-282-2400
Mailing Address - Fax:410-282-4100
Practice Address - Street 1:1003 NORTH POINT BLVD
Practice Address - Street 2:SUITE 603
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:410-282-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD51261223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T59643Medicare UPIN