Provider Demographics
NPI:1548229859
Name:MARTIN Z. KANNER, M.D., P.A.
Entity Type:Organization
Organization Name:MARTIN Z. KANNER, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:ZELIG
Authorized Official - Last Name:KANNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-486-0927
Mailing Address - Street 1:1700 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 224
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1416
Mailing Address - Country:US
Mailing Address - Phone:410-486-0927
Mailing Address - Fax:410-358-4020
Practice Address - Street 1:1700 REISTERSTOWN RD
Practice Address - Street 2:SUITE 224
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-1416
Practice Address - Country:US
Practice Address - Phone:410-486-0927
Practice Address - Fax:410-358-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020618261QM1300X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Not Answered261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0020618OtherSTATE LICENSE
MDM04706OtherSTATE DEA
AK7595551OtherFEDERAL DEA
MDB70288Medicare UPIN
MDD0020618OtherSTATE LICENSE