Provider Demographics
NPI:1003891375
Name:KLOTZMAN, LEWIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:KLOTZMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5922 YORK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3028
Mailing Address - Country:US
Mailing Address - Phone:410-532-3070
Mailing Address - Fax:510-532-3101
Practice Address - Street 1:5922 YORK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3028
Practice Address - Country:US
Practice Address - Phone:410-532-3070
Practice Address - Fax:510-532-3101
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00953213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD429248100Medicaid
MD429248100Medicaid
T59879Medicare UPIN