Provider Demographics
NPI:1235146572
Name:KATZ, MYRA (PA)
Entity Type:Individual
Prefix:
First Name:MYRA
Middle Name:
Last Name:KATZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MYRA
Other - Middle Name:
Other - Last Name:MARGOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7106 PHEASANT CROSS DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1024
Mailing Address - Country:US
Mailing Address - Phone:410-484-2927
Mailing Address - Fax:
Practice Address - Street 1:5601 LOCH RAVEN BLVD
Practice Address - Street 2:SMYTH SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239
Practice Address - Country:US
Practice Address - Phone:443-444-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC01263363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP02073Medicare UPIN
MDH522Medicare ID - Type Unspecified