Provider Demographics
NPI:1689716813
Name:JOHN P. KATZENBERG
Entity Type:Organization
Organization Name:JOHN P. KATZENBERG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KATZENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-448-6855
Mailing Address - Street 1:292 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450
Mailing Address - Country:US
Mailing Address - Phone:978-448-6855
Mailing Address - Fax:978-448-2202
Practice Address - Street 1:292 MAIN ST.
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450
Practice Address - Country:US
Practice Address - Phone:978-448-6855
Practice Address - Fax:978-448-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6181708Medicaid
MA6181708Medicaid