Provider Demographics
NPI:1013170067
Name:KATSNELSON, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KATSNELSON
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 1:1500 PALMA DR # 298
Mailing Address - Street 2:#609
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6451
Mailing Address - Country:US
Mailing Address - Phone:443-622-5894
Mailing Address - Fax:
Practice Address - Street 1:8000 TOWERS CRESCENT DR
Practice Address - Street 2:STE 1350
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-6207
Practice Address - Country:US
Practice Address - Phone:866-450-1918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS222632084N0400X
ARE-85112084N0400X
TN470442084N0400X
FLME1071442084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology