Provider Demographics
NPI:1144220732
Name:HOLMES, MORGAN TIMOTHY (DPM)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:TIMOTHY
Last Name:HOLMES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTH EAST
Mailing Address - State:PA
Mailing Address - Zip Code:16428-1319
Mailing Address - Country:US
Mailing Address - Phone:814-725-2715
Mailing Address - Fax:814-725-5186
Practice Address - Street 1:90 E MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1319
Practice Address - Country:US
Practice Address - Phone:814-725-2715
Practice Address - Fax:814-725-5186
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2010-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003377L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA481559OtherHIGHMARK
PA0012954200006Medicaid
PA481559OtherHIGHMARK
PA0012954200006Medicaid