DR. MARK ANTHONY LIZAK (NPI# 1790759934) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790759934 |
| Entity Type | Individual |
| Full Name | DR. MARK ANTHONY LIZAK |
| Credential | MD |
| Practice Address |
14 Medical Center Drive Supply NC 28462-3350 |
| Practice Telephone | 9107542920 |
| Practice Fax Number | 9107542268 |
| Mailing Telephone | 9107542920 |
| Mailing Fax Number | 9107542268 |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2011-10-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207YX0901X |
Otolaryngology Specialization: Otology & Neurotology |
35760 | NC | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | BCBS | 0295N | 01 |
| NC | 8952324 | 05 |
| Street Address |
14 MEDICAL CENTER DRIVE |
| City | SUPPLY |
| State | NC |
| Zip Code | 28462-3350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699782334 | Carolinas Ear Nose & Throat Center | Otolaryngology | 14 Medical Center Drive, Supply, NC 28462-3350 | 2006-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558910943 | Lisa M Jock | Technician | 1276 Skipper Run Sw, Supply, NC 28462 | 2019-09-09 |
| 1023532686 | Novant Health Brunswick Endoscopy Center, LLC | Nurse Anesthetist, Certified Registered | 13 Medical Campus Drive, Suite 101, Supply, NC 28462 | 2017-07-26 |
| 1821510579 | Novant Health Brunswick Endoscopy Center, LLC | Clinic/Center | 13 Medical Campus Dr, Suite 101, Supply, NC 28462 | 2017-07-14 |
| 1831461920 | Reginald Lofton Hewett | Counselor | 1473 Cedar Grove Rd, Supply, NC 28462 | 2012-02-03 |
| 1760793343 | Coastal Hearing Centers, Inc | Clinic/Center | 2298 Ocean Hwy, Supply, NC 28462 | 2010-06-29 |
| 1083943567 | Lorell Sneeden Pait | Nurse Practitioner | 795 Ocean Highway West, Supply, NC 28462 | 2009-12-14 |
| 1043451321 | Well Care Home Care | Home Health | 118 Ocean Highway West, Supply, NC 28462 | 2009-03-16 |
| 1467672873 | South Atlantic Radiation Oncology, LLC | Clinic/Center | 545 Ocean Highway West, Supply, NC 28462 | 2007-04-26 |
| 1225177702 | Barbara C Bauer | Counselor | 1041 Old Ocean Highway, Supply, NC 28462 | 2007-02-05 |
| 1891852323 | Liberty Medical Specialties, Inc | Durable Medical Equipment & Medical Supplies | 1120 Ocean Hwy West, Supply, NC 28462 | 2007-01-03 |
| Find all providers in zip 28462 | ||||
| Taxonomy Code | 207YX0901X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| Specialization | Otology & Neurotology |
| An otolaryngologist who treats diseases of the ear and temporal bone, including disorders of hearing and balance. The additional training in otology and neurotology emphasizes the study of embryology, anatomy, physiology, epidemiology, pathophysiology, pathology, genetics, immunology, microbiology and the etiology of diseases of the ear and temporal bone. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added] Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699782334 | Carolinas Ear Nose & Throat Center | Otolaryngology | 14 Medical Center Drive, Supply, NC 28462-3350 | 2006-08-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699774000 | Calhoun D Cunningham IIi | Otolaryngology | 3100 Duraleigh Rd, Suite 300, Raleigh, NC 27612-8104 | 2005-07-18 |
| 1447259858 | John T Mcelveen Jr. | Otolaryngology | 5900 Six Forks Rd, Suite 200, Raleigh, NC 27609-3838 | 2005-07-18 |
| 1184910614 | Matthew Dedmon | Otolaryngology | 101 Manning Dr, Chapel Hill, NC 27599 | 2011-06-23 |
| 1023309564 | Jonathan Maslan | Otolaryngology | Medical Center Blvd, Winston Salem, NC 27157-0001 | 2011-05-01 |
| 1619170529 | Deidra Blanks | Otolaryngology | 6752 Rock Spring Rd, Wilmington, NC 28405-3179 | 2007-06-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.