Provider Demographics
NPI:1215904990
Name:GRATZ, EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:GRATZ
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 1:2435 W BELVEDERE AVE
Mailing Address - Street 2:SUITE 32
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5224
Mailing Address - Country:US
Mailing Address - Phone:410-601-8300
Mailing Address - Fax:410-601-8227
Practice Address - Street 1:2435 W BELVEDERE AVE
Practice Address - Street 2:SUITE 32
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215-5224
Practice Address - Country:US
Practice Address - Phone:410-601-8300
Practice Address - Fax:410-601-8227
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD26363174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD343161400Medicaid
MDB69904Medicare UPIN