MEDICARE: ALAN M KATZ PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	0810001334	VA
2	103TC0700X	Clinical Psychologist	0810001334	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	264464	OTHER	VA	PSYCHOLOGIST
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952302127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALAN M KATZ PH.D.

Provider Business Mailing Address
First Line	:	4330 OLD CAVE SPRING RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3419
Country	:	US
Telephone Number	:	540-774-4211
Fax Number	:	540-989-8793

Provider Business Practice Location Address
First Line	:	4330 OLD CAVE SPRING RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-3419
Country	:	US
Telephone Number	:	540-774-4211
Fax Number	:	540-989-8793

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	05/06/2008

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