Provider Demographics
NPI:1326614116
Name:MIZERAK, MARYLENA ROSE (MD)
Entity type:Individual
Prefix:
First Name:MARYLENA
Middle Name:ROSE
Last Name:MIZERAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1540 ALEXANDRA LN
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17110-3656
Mailing Address - Country:US
Mailing Address - Phone:717-798-3363
Mailing Address - Fax:717-798-3364
Practice Address - Street 1:1540 ALEXANDRA LN
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17110-3656
Practice Address - Country:US
Practice Address - Phone:717-798-3363
Practice Address - Fax:717-798-3364
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD486010207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine