Provider Demographics
NPI:1093711830
Name:KATZEN, DAVID ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ROBERT
Last Name:KATZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 BALD HILL RD
Mailing Address - Street 2:STE 527
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-6100
Mailing Address - Country:US
Mailing Address - Phone:401-739-5901
Mailing Address - Fax:401-739-8170
Practice Address - Street 1:400 BALD HILL RD
Practice Address - Street 2:STE 527
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-6100
Practice Address - Country:US
Practice Address - Phone:401-739-5901
Practice Address - Fax:401-739-8170
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD06041207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000465Medicaid
RIC89692Medicare UPIN