Provider Demographics
NPI:1780693820
Name:KATZ, DOUGLAS MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:MICHAEL
Last Name:KATZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:323 LOWELL ST
Mailing Address - Street 2:ANDOVER MEDICAL CENTER & EXPRESS CARE
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-4501
Mailing Address - Country:US
Mailing Address - Phone:978-783-5000
Mailing Address - Fax:978-313-8188
Practice Address - Street 1:323 LOWELL ST
Practice Address - Street 2:ANDOVER MEDICAL CENTER & EXPRESS CARE
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-4501
Practice Address - Country:US
Practice Address - Phone:978-783-5000
Practice Address - Fax:978-313-8188
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA70570207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3070131Medicaid
J16032OtherMEDICARE
MA3070131Medicaid