Provider Demographics
NPI:1104894781
Name:GARONZIK, IRA MARTIN (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:MARTIN
Last Name:GARONZIK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5051 GREENSPRING AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4354
Mailing Address - Country:US
Mailing Address - Phone:410-664-3680
Mailing Address - Fax:410-664-3686
Practice Address - Street 1:5051 GREENSPRING AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-4354
Practice Address - Country:US
Practice Address - Phone:410-664-3680
Practice Address - Fax:410-664-3686
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2014-01-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0057725207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH63595Medicare UPIN