Provider Demographics
NPI:1326546045
Name:DATZ, HOWARD
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:
Last Name:DATZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8229 KINGS CHARTER LN APT G
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-4112
Mailing Address - Country:US
Mailing Address - Phone:571-721-8012
Mailing Address - Fax:703-451-9669
Practice Address - Street 1:6880 COMMERCIAL DR # 38
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-4201
Practice Address - Country:US
Practice Address - Phone:571-721-8012
Practice Address - Fax:703-451-9669
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-28
Last Update Date:2018-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies