1164603759 NPI number — NICOLE MARLENE HOLLIDAY D.O.

Table of content: NICOLE MARLENE HOLLIDAY D.O. (NPI 1164603759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164603759 NPI number — NICOLE MARLENE HOLLIDAY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLLIDAY
Provider First Name:
NICOLE
Provider Middle Name:
MARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164603759
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1803 MOUNT ROSE AVE
Provider Second Line Business Mailing Address:
SUITE B3
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17403-3026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-851-1405
Provider Business Mailing Address Fax Number:
717-337-4249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
147 GETTYS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GETTYSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17325-2534
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-337-4216
Provider Business Practice Location Address Fax Number:
717-337-4249
Provider Enumeration Date:
11/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  OS015219 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 102482298 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1589518 . This is a "GATEWAY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2511942 . This is a "HIGHMARK BLUE SHIELD-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 310452 . This is a "UNISON-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30077871 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 311595 . This is a "UNITED HEALTHCARE COMM PLAN-YH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30080144 . This is a "AMERIHEALTH MERCY-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 415244 . This is a "UPMC-WMG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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