Provider Demographics
NPI:1558654418
Name:MIZUS, MARISA CARLY (MD)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CARLY
Last Name:MIZUS
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2435 W BELVEDERE AVE STE 22
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5224
Mailing Address - Country:US
Mailing Address - Phone:410-601-8389
Mailing Address - Fax:410-601-4833
Practice Address - Street 1:10753 FALLS RD STE 225
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-4597
Practice Address - Country:US
Practice Address - Phone:410-583-2604
Practice Address - Fax:410-583-2841
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2024-04-08
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Provider Licenses
StateLicense IDTaxonomies
PAMD449982207R00000X
MDD83503208M00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist