Provider Demographics
NPI:1730170101
Name:KATZ, GERALD B (MD)
Entity type:Individual
Prefix:MR
First Name:GERALD
Middle Name:B
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 1:549 COLUMBIAN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOUTH WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02190-1138
Mailing Address - Country:US
Mailing Address - Phone:781-337-5680
Mailing Address - Fax:781-337-3275
Practice Address - Street 1:549 COLUMBIAN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-1138
Practice Address - Country:US
Practice Address - Phone:781-337-5680
Practice Address - Fax:781-337-3275
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34409208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2016222Medicaid
MA20534OtherHPHC
MAKAB33362OtherBCBS
355285OtherCIGNA
034409OtherTUFTS
419427OtherTUFTS USFHP
E03005Medicare UPIN
355285OtherCIGNA