1295727105 NPI number — MR. DONALD HOLZER MD

Table of content: MR. DONALD HOLZER MD (NPI 1295727105)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295727105 NPI number — MR. DONALD HOLZER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLZER
Provider First Name:
DONALD
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1295727105
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3315 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23707-3319
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-399-0759
Provider Business Mailing Address Fax Number:
757-397-8957

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3315 HIGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTSMOUTH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23707-3319
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-399-0759
Provider Business Practice Location Address Fax Number:
757-397-8957
Provider Enumeration Date:
08/17/2005

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: 2084P2900X , with the licence number:  0101234003 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0500834 . This is a "TRICARE STANDARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7119291 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 150684200 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "MIDATLANTIC HEALTH SOLUTI" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00022532 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 465352 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0500834 . This is a "PHYSICIAN NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "HEALTH NETWORK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 465352 . This is a "BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "BENESIGHT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6086731015 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 465352 . This is a "HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 465352 . This is a "PENINSULA HEALTHCARE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 465352 . This is a "PRIORITY HEALTH CARE INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54-1951442 . This is a "FOCUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89066VY , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 54-1951442 . This is a "CORVEL WC PROVIDER NETWOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 69674 . This is a "SENTRA" identifier . This identifiers is of the category "OTHER".




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