Provider Demographics
NPI:1962585208
Name:GRETZ, DAWN MARIE (DPM)
Entity type:Individual
Prefix:DR
First Name:DAWN
Middle Name:MARIE
Last Name:GRETZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 MADISON PARK DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-5627
Mailing Address - Country:US
Mailing Address - Phone:410-761-1666
Mailing Address - Fax:410-768-5809
Practice Address - Street 1:1405 MADISON PARK DR
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-5613
Practice Address - Country:US
Practice Address - Phone:410-761-1666
Practice Address - Fax:410-768-5809
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01219213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD368778300Medicaid
MDU56859Medicare UPIN
MD990L638EMedicare PIN
MD4837320001Medicare NSC