Provider Demographics
NPI:1497037303
Name:ZATZ, MARTIN (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:
Last Name:ZATZ
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4853 CORDELL AVE
Mailing Address - Street 2:#1009
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814
Mailing Address - Country:US
Mailing Address - Phone:301-656-3894
Mailing Address - Fax:
Practice Address - Street 1:4853 CORDELL AVE
Practice Address - Street 2:#1009
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-7055
Practice Address - Country:US
Practice Address - Phone:301-656-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00173441744R1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744R1102XOther Service ProvidersSpecialistResearch Study
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0017344OtherLICENSE CERT NO.