Healthcare Provider Details

I. General information

NPI: 1255394557
Provider Name (Legal Business Name): MATTHEW S. KAATZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 1ST ST NW
PULASKI VA
24301-5603
US

IV. Provider business mailing address

101 1ST ST NW P. O. BOX 1641
PULASKI VA
24301-5603
US

V. Phone/Fax

Practice location:
  • Phone: 540-980-0550
  • Fax: 540-980-9141
Mailing address:
  • Phone: 540-980-0550
  • Fax: 540-980-9141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101221492
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number044253
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: