Provider Demographics
NPI:1265492516
Name:KATLIC, MARK RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:RICHARD
Last Name:KATLIC
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Gender:M
Credentials:MD
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Mailing Address - Street 1:2401 WEST BELVEDERE AVENUE
Mailing Address - Street 2:SINAI HOSPITAL DEPARTMENT OF SURGERY
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-601-5547
Mailing Address - Fax:410-601-5835
Practice Address - Street 1:2401 WEST BELVEDERE AVENUE
Practice Address - Street 2:SINAI HOSPITAL OF BALTIMORE
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-601-5547
Practice Address - Fax:410-601-5835
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-02-24
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Provider Licenses
StateLicense IDTaxonomies
PAMD029769E208600000X, 208G00000X
MDD72906208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001492250Medicaid
PA444134Medicare ID - Type Unspecified