Individual
ELLIS MEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1645 LIBERTY RD, SUITE 204, ELDERSBURG, MD 21784-6521
(410) 795-7737
(410) 795-2828
Mailing address
1645 LIBERTY RD, SUITE 204, ELDERSBURG, MD 21784-6521
(410) 795-7737
(410) 795-2828
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D22220
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
245377YEVB
MEDICARE ID
MD
05
—
328231700
—
MD
Enumeration date
08/09/2006
Last updated
08/12/2013
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