Healthcare Provider Details

I. General information

NPI: 1548229859
Provider Name (Legal Business Name): MARTIN Z. KANNER, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 REISTERSTOWN RD SUITE 224
BALTIMORE MD
21208-1416
US

IV. Provider business mailing address

1700 REISTERSTOWN RD SUITE 224
BALTIMORE MD
21208-1416
US

V. Phone/Fax

Practice location:
  • Phone: 410-486-0927
  • Fax: 410-358-4020
Mailing address:
  • Phone: 410-486-0927
  • Fax: 410-358-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberD0020618
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberD0020618
License Number StateMD

VIII. Authorized Official

Name: DR. MARTIN ZELIG KANNER
Title or Position: OFFICER
Credential: MD
Phone: 410-486-0927