Provider Demographics
NPI:1740377316
Name:DR BURTON J KATZEN D P M LLC
Entity type:Organization
Organization Name:DR BURTON J KATZEN D P M LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:DR
Authorized Official - First Name:BURTON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KATZEN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-423-9494
Mailing Address - Street 1:4302 SAINT BARNABAS RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1842
Mailing Address - Country:US
Mailing Address - Phone:301-423-9494
Mailing Address - Fax:301-423-7960
Practice Address - Street 1:4302 SAINT BARNABAS RD
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-1842
Practice Address - Country:US
Practice Address - Phone:301-423-9494
Practice Address - Fax:301-423-7960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00317213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5860070001Medicare NSC
MD192156Medicare ID - Type Unspecified
MDT30880Medicare UPIN