Provider Demographics
NPI:1366984171
Name:KATZ, BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
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 1:10000 VIRGINIA MANOR RD
Mailing Address - Street 2:STE 350
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-4201
Mailing Address - Country:US
Mailing Address - Phone:844-347-6871
Mailing Address - Fax:844-347-6870
Practice Address - Street 1:10000 VIRGINIA MANOR RD
Practice Address - Street 2:STE 350
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-4201
Practice Address - Country:US
Practice Address - Phone:844-347-6871
Practice Address - Fax:844-347-6870
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0082445208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice