Provider Demographics
NPI:1457306466
Name:KATZ, MATTHEW HAROLD (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:HAROLD
Last Name:KATZ
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 1:11510 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2736
Mailing Address - Country:US
Mailing Address - Phone:301-881-4124
Mailing Address - Fax:301-881-6505
Practice Address - Street 1:11510 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2736
Practice Address - Country:US
Practice Address - Phone:301-881-4124
Practice Address - Fax:301-881-6505
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45413207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC816067800Medicaid
DCF75746Medicare UPIN
DC816067800Medicaid