Basic Information
| Provider Information | |||||||||
| NPI: | 1376014779 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOETZ | ||||||||
| FirstName: | TZIPORA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3407 SEVEN MILE LN | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212085636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4439551118 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1838 GREENE TREE RD STE 400 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212087103 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106027782 | ||||||||
| FaxNumber: | 4106029344 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2018 | ||||||||
| LastUpdateDate: | 12/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R189441 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.