Provider Demographics
NPI:1720059736
Name:MEZEBISH, DAVID S (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:MEZEBISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:75 THOMAS JOHNSON DR STE H
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4895
Mailing Address - Country:US
Mailing Address - Phone:301-668-9850
Mailing Address - Fax:301-668-9853
Practice Address - Street 1:75 THOMAS JOHNSON DR STE H
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4895
Practice Address - Country:US
Practice Address - Phone:301-668-9850
Practice Address - Fax:301-668-9853
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232840207ND0900X, 207NI0002X, 207NS0135X, 207ND0101X
MDD0043824207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010165156Medicaid
WV001734127OtherMTST BCBS
WV3810002827Medicaid
VA180145OtherANTHEM BLUE CROSS BLUE SHIELD OF VIRGINIA
MD61854810OtherCAREFIRST BLUE CROSS BLUE SHIELD
VAP00252754OtherRR MEDICARE
MD0001OtherBLUE CROSS BLUE SHIELD FEDERAL
MD0001OtherBLUE CROSS BLUE SHIELD FEDERAL
VA010165156Medicaid
VA180145OtherANTHEM BLUE CROSS BLUE SHIELD OF VIRGINIA