Healthcare Provider Details

I. General information

NPI: 1255410825
Provider Name (Legal Business Name): MAYER M KATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 02/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33664 BAYVIEW MEDICAL DR UNIT 2
LEWES DE
19958-1687
US

IV. Provider business mailing address

33664 BAYVIEW MEDICAL DR UNIT 2
LEWES DE
19958-1687
US

V. Phone/Fax

Practice location:
  • Phone: 302-644-4954
  • Fax: 302-645-5481
Mailing address:
  • Phone: 302-644-4954
  • Fax: 302-645-5481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC1-0003486
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: