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
State | License ID | Taxonomies |
---|---|---|
SC | 19100 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
SC | 191009 | Medicaid | |
SC | 1487807871 | Other | SITE NPI# |
SD | GP4992 | Other | MEDICAID GROUP# |
SC | 191009 | Medicaid | |
SC | 191009 | Medicaid | |
SC | G93472 | Medicare UPIN | |
SC | G934725281 | Medicare PIN | |
SC | SC86489223 | Medicare PIN |