Active NPI
David Leslie Zisow, MD
- Gynecology Physician
- Forest Hill, MD
National Provider Identifier
1124024500
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- D0017174
- Practice address
- 2005 Rock Spring Rd
Suite 3
Forest Hill, MD 21050-2621 - Phone
- (410) 879-1139
- Fax
- (410) 893-1158
- NPI assigned
- Jun 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | D0017174 | MD | Primary |
| Gynecology Physician | 207VG0400X | ME91824 | FL |
Addresses
Primary practice location
2005 Rock Spring Rd
Suite 3
Forest Hill, MD 21050-2621
Mailing address
2005 Rock Spring Rd
Suite 3
Forest Hill, MD 21050-2621
Phone (410) 879-1139
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 972911900 | Medicaid | MD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ME91824 | FL | MD | Gynecology Physician |
| D0017174 | MD | MD | Gynecology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Saint Joseph Medical Center , Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Multi-Specialty Clinic/Center
- Towson, MD
- NPI 1699862961
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1274140800000",
"number": "1124024500",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2005 ROCK SPRING RD",
"address_2": "SUITE 3",
"city": "FOREST HILL",
"state": "MD",
"postal_code": "210502621",
"telephone_number": "410-879-1139",
"fax_number": "410-893-1158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2005 ROCK SPRING RD",
"address_2": "SUITE 3",
"city": "FOREST HILL",
"state": "MD",
"postal_code": "210502621",
"telephone_number": "410-879-1139",
"fax_number": "410-893-1158"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZISOW",
"first_name": "DAVID",
"middle_name": "LESLIE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-22",
"last_updated": "2010-05-18",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "MD",
"license": "D0017174",
"primary": true
},
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "FL",
"license": "ME91824",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "972911900",
"state": "MD"
}
],
"endpoints": [],
"other_names": []
}Other providers in Forest Hill, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.