Provider Demographics
NPI:1700049103
Name:MOATZ, BRADLEY WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:WILLIAM
Last Name:MOATZ
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 1:3333 N CALVERT ST STE 655
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-6516
Mailing Address - Country:US
Mailing Address - Phone:410-554-2867
Mailing Address - Fax:410-554-2917
Practice Address - Street 1:3333 N CALVERT ST STE 655
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-6516
Practice Address - Country:US
Practice Address - Phone:410-554-2867
Practice Address - Fax:410-554-2917
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA71264207X00000X
MDD79199207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD095853100Medicaid
MD423984ZANWMedicare PIN