Provider Demographics
NPI:1952480139
Name:KATZ, MARTIN D (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:D
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 1:190 JAMES RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24590-3812
Mailing Address - Country:US
Mailing Address - Phone:434-286-2025
Mailing Address - Fax:
Practice Address - Street 1:190 JAMES RIVER RD
Practice Address - Street 2:
Practice Address - City:SCOTTSVILLE
Practice Address - State:VA
Practice Address - Zip Code:24590-3812
Practice Address - Country:US
Practice Address - Phone:434-286-2025
Practice Address - Fax:434-321-5259
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11227207Q00000X
VA0101222055207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA08007125Medicaid
VAG70485Medicare UPIN
VA005642906Medicare ID - Type Unspecified