Provider Demographics
NPI:1912190117
Name:ROBERT KATZ & MATTHEW KATZ MD PA
Entity Type:Organization
Organization Name:ROBERT KATZ & MATTHEW KATZ MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NEVILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ST AUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-881-4121
Mailing Address - Street 1:11510 OLD GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2736
Mailing Address - Country:US
Mailing Address - Phone:301-881-4121
Mailing Address - Fax:301-881-6505
Practice Address - Street 1:11510 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2736
Practice Address - Country:US
Practice Address - Phone:301-881-4121
Practice Address - Fax:301-881-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC816067800Medicaid
DC816067800Medicaid