Provider Demographics
NPI:1417983016
Name:BALTATZIS, PANAYIOTIS A (MD)
Entity Type:Individual
Prefix:
First Name:PANAYIOTIS
Middle Name:A
Last Name:BALTATZIS
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 1:8113 HARFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5707
Mailing Address - Country:US
Mailing Address - Phone:410-882-4800
Mailing Address - Fax:410-882-6667
Practice Address - Street 1:8113 HARFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-5707
Practice Address - Country:US
Practice Address - Phone:410-882-4800
Practice Address - Fax:410-882-6667
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0028949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD359441600OtherMEDICAL ASSISTANCE
GA010019494OtherRAILROAD MEDICARE
MD199472YDHYOtherMEDICARE
MD2110OtherMEDICARE
GA010019494OtherRAILROAD MEDICARE