Provider Demographics
NPI:1629047154
Name:KATZ, PAUL M (DO)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:KATZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:CECILTON
Mailing Address - State:MD
Mailing Address - Zip Code:21913-0669
Mailing Address - Country:US
Mailing Address - Phone:410-275-8156
Mailing Address - Fax:877-433-6830
Practice Address - Street 1:251 BOHEMIA AVE
Practice Address - Street 2:
Practice Address - City:CECILTON
Practice Address - State:MD
Practice Address - Zip Code:21913-0000
Practice Address - Country:US
Practice Address - Phone:410-275-8157
Practice Address - Fax:877-433-6830
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0056426207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD080171527OtherMEDICARE RAILROAD
MD536RMedicare PIN
MD080171527OtherMEDICARE RAILROAD