Mark Anthony Lizak, MD

Primary specialty

Otology & Neurotology PhysicianTaxonomy code 207YX0901X

License

35760 Issued in NC

Practice address

14 Medical Center Drive
Supply, NC 28462-3350

Phone

(910) 754-2920

Fax

(910) 754-2268

NPI assigned

Feb 15, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1790759934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14 MEDICAL CENTER DRIVE",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284623350",
            "telephone_number": "910-754-2920",
            "fax_number": "910-754-2268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 MEDICAL CENTER DRIVE",
            "city": "SUPPLY",
            "state": "NC",
            "postal_code": "284623350",
            "telephone_number": "910-754-2920",
            "fax_number": "910-754-2268"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIZAK",
        "first_name": "MARK",
        "middle_name": "ANTHONY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0901X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Otology & Neurotology",
            "state": "NC",
            "license": "35760",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0295N",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8952324",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Liberty Medical Specialties, Inc
• Liberty Nursing Services, LLC (Liberty Nursing Services)
• Life, Inc. (Life, Inc./Folly Street Group Home)
• Life, Inc. (Life, Inc./Lockwood Street Group Home)
• Autumn Jean Littlebrant, LCSW
• Daniel B. Maccallum, MD
• Michelle Catherine Mackay
• Deanna England Maclaren, FNPC
• Amber Mae Marchio, AGNP-C
• Anthony R Markham, P.T.

• Otology & Neurotology Physician in Supply, NC
• Providers in Supply, NC by specialty
• Otology & Neurotology Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.