Provider Demographics
NPI:1164450920
Name:SCHULTZ, HOWARD KENNETH JR (MD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:KENNETH
Last Name:SCHULTZ
Suffix:JR
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 1:1438 DEFENSE HIGHWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054
Mailing Address - Country:US
Mailing Address - Phone:410-721-3200
Mailing Address - Fax:410-721-2680
Practice Address - Street 1:1438 DEFENSE HIGHWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:GAMBRILLS
Practice Address - State:MD
Practice Address - Zip Code:21054
Practice Address - Country:US
Practice Address - Phone:410-721-3200
Practice Address - Fax:410-721-2680
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD35848207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
9262313OtherCHOICE CARE
MD819172OtherFIRST HEALTH
2845851100OtherMEDICAL ASSISTANCE
819172OtherCCN
7567HKOtherBLUECROSS BLUESHIELD
C0850001OtherBLUECROSS BLUESHIELD FEDE
20886OtherJOHN HOPKINS HEALTH CARE
323179OtherALLIANCE
323179OtherMAMSI
643065OtherINFORMED
MD284851100Medicaid
522281410OtherCOVENTRY HEALTH
522281410OtherFIDELITY
P11392OtherBLUECROSS BLUESHIELD MPOS
40305782OtherAETNA
723256OtherNCPPO
C0850001OtherCAREFIRST BLUECHOICE