Healthcare Provider Details

I. General information

NPI: 1215748447
Provider Name (Legal Business Name): KATZEN MEDICAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 04/22/2025
Certification Date: 04/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 BOX HILL CORPORATE CENTER DR STE 202
ABINGDON MD
21009-1200
US

IV. Provider business mailing address

3401 BOX HILL CORPORATE CENTER DR STE 202
ABINGDON MD
21009-0000
US

V. Phone/Fax

Practice location:
  • Phone: 410-569-0707
  • Fax: 410-569-0711
Mailing address:
  • Phone: 410-569-0707
  • Fax: 410-569-0711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS DUDLEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 920-915-5202