Provider Demographics
NPI:1144372202
Name:BEZIRDJIAN, LAURENCE C (MD)
Entity type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:C
Last Name:BEZIRDJIAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3455 WILKENS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21229-5213
Mailing Address - Country:US
Mailing Address - Phone:410-646-0330
Mailing Address - Fax:410-644-6182
Practice Address - Street 1:3455 WILKENS AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21229-5213
Practice Address - Country:US
Practice Address - Phone:410-646-0330
Practice Address - Fax:410-644-6182
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028045208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD40766OtherMAMSI PROVIDER NUMBER
MD1900619OtherAMERICHOICE PROV. NUMBER
MD20679013OtherUNITED HEALTHCARE PROV.
MDE6120001OtherBCBS FEDERAL
MDE6120001OtherBLUE CHOICE
MD41096803OtherCAREFIRST BCBS OF MD
MD465491900Medicaid
MD40766OtherMAMSI PROVIDER NUMBER
MDE6120001OtherBCBS FEDERAL
522075723OtherTIN
MD1900619OtherAMERICHOICE PROV. NUMBER