Provider Demographics
NPI:1659322881
Name:MAIZEL, SCOTT E (MD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:E
Last Name:MAIZEL
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:PO BOX 418953
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-8953
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:ROOM 3105
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-2600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD29802208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD322371000Medicaid
MDKJ31GB/41733503OtherCAREFIRST MARYLAND GBMC
MDS131/0003OtherCAREFIRST REGIONAL GBMC
MD322371000Medicaid
MD703LN207Medicare PIN
MDP00346593Medicare PIN
MDS131/0003OtherCAREFIRST REGIONAL GBMC