Healthcare Provider Details

I. General information

NPI: 1578650354
Provider Name (Legal Business Name): RICHARD M KATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W. ROGERS AVE
BALTIMORE MD
21209-4596
US

IV. Provider business mailing address

1708 W. ROGERS AVE
BALTIMORE MD
21209-4596
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-8600
  • Fax:
Mailing address:
  • Phone: 410-578-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberBH2063369
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: