Provider Demographics
NPI:1942266507
Name:KATZ, BARRY STEPHEN (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:STEPHEN
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 HARTH PL
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8107
Mailing Address - Country:US
Mailing Address - Phone:843-875-7901
Mailing Address - Fax:843-832-2038
Practice Address - Street 1:102 HARTH PL
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8107
Practice Address - Country:US
Practice Address - Phone:843-875-7901
Practice Address - Fax:843-832-2038
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19100207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC191009Medicaid
SC1487807871OtherSITE NPI#
SDGP4992OtherMEDICAID GROUP#
SC191009Medicaid
SC191009Medicaid
SCG93472Medicare UPIN
SCG934725281Medicare PIN
SCSC86489223Medicare PIN