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General NPI Number Information
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NPI Number | 1326542440
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Entity Type | Individual
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Provider Name | KATHERINE NEITZKE MD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2018
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 1111 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21201-5505
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Country | US
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Telephone | 108-372-0504
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Fax | 866-629-0091
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Provider Business Mailing Address
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Address Line | 1111 N CHARLES ST
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City | BALTIMORE
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State | MD
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Zip | 21201-5505
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Country | US
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Telephone | 108-372-0504
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Fax | 866-629-0091
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0091098
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ML60850747
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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