Provider Demographics
NPI:1710965405
Name:KATZENBERG, CHARLES A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:A
Last Name:KATZENBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3375 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2306
Mailing Address - Country:US
Mailing Address - Phone:520-838-2105
Mailing Address - Fax:520-838-2260
Practice Address - Street 1:2404 E RIVER RD
Practice Address - Street 2:BUILDING 2, STE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-6520
Practice Address - Country:US
Practice Address - Phone:520-696-4780
Practice Address - Fax:520-293-7024
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ12180207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ221341Medicaid
AZZ20489Medicare PIN
AZ221341Medicaid
C99739Medicare UPIN
AZZ20490Medicare PIN