Provider Demographics
NPI:1821002387
Name:HARTZ, BENJAMIN ALLAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ALLAN
Last Name:HARTZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 LORD BALTIMORE DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21244
Mailing Address - Country:US
Mailing Address - Phone:443-316-2101
Mailing Address - Fax:410-265-6068
Practice Address - Street 1:7551 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3403
Practice Address - Country:US
Practice Address - Phone:301-807-1174
Practice Address - Fax:301-982-2300
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC0512152W00000X
MDTA0863152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist