Provider Demographics
NPI:1891988440
Name:PANAYIOTIS A. BALTATZIS, M.D., P.A.
Entity Type:Organization
Organization Name:PANAYIOTIS A. BALTATZIS, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:PANAYIOTIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BALTATZIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-882-4800
Mailing Address - Street 1:8113 HARFORD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-5707
Mailing Address - Country:US
Mailing Address - Phone:410-882-4800
Mailing Address - Fax:410-882-6667
Practice Address - Street 1:8113 HARFORD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-5707
Practice Address - Country:US
Practice Address - Phone:410-882-4800
Practice Address - Fax:410-882-6667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2011-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00288949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD199449OtherMEDICARE
GAPENDINGOtherRAILROAD MEDICARE
GAPENDINGOtherRAILROAD MEDICARE