Provider Demographics
NPI:1851499768
Name:KURTZ PHELAN, DOROTHY H (DPM)
Entity Type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:H
Last Name:KURTZ PHELAN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:H
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:5730 EXECUTIVE DR STE 230
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-1762
Mailing Address - Country:US
Mailing Address - Phone:978-536-7850
Mailing Address - Fax:978-536-7851
Practice Address - Street 1:100 BROOKSBY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1438
Practice Address - Country:US
Practice Address - Phone:978-536-7850
Practice Address - Fax:978-536-7851
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPOD1030213E00000X
MA2374213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME200148199OtherTAX ID #
NH03Y002802ME02OtherANTHEM NH
ME22010099OtherMAINECARE IND#
ME060678OtherANTHEM
ME1841270642OtherGROUP NPI#
ME1851499768OtherINDIVIDUAL NPI #
NH03Y002802ME02OtherANTHEM NH
ME1851499768OtherINDIVIDUAL NPI #