Provider Demographics
NPI:1740572437
Name:DANTZER, PATRICK LEON
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:LEON
Last Name:DANTZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7671 QUARTERFIELD RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4998
Mailing Address - Country:US
Mailing Address - Phone:443-270-6760
Mailing Address - Fax:410-760-4830
Practice Address - Street 1:7671 QUARTERFIELD RD
Practice Address - Street 2:SUITE 401
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4998
Practice Address - Country:US
Practice Address - Phone:443-270-6760
Practice Address - Fax:410-760-4830
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2015-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079276207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics