Provider Demographics
NPI:1487978359
Name:KATZ, MATTHEW SAMUEL JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:SAMUEL JOSEPH
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:PO BOX 158281
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-8281
Mailing Address - Country:US
Mailing Address - Phone:615-306-1075
Mailing Address - Fax:
Practice Address - Street 1:342 22ND AVE N
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203
Practice Address - Country:US
Practice Address - Phone:615-327-2001
Practice Address - Fax:615-234-2015
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455934207W00000X
MDD0077731207W00000X
TN56785207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1487978359Medicaid
MD0799173 00Medicaid
DC094268100Medicaid
MD0799173 00Medicaid
DC357831ZA9WMedicare PIN
VA1487978359Medicaid