Provider Demographics
NPI:1154649937
Name:HOLTGATE PODIATRY PLLC
Entity Type:Organization
Organization Name:HOLTGATE PODIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOLTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:717-731-1133
Mailing Address - Street 1:PO BOX 415
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-0415
Mailing Address - Country:US
Mailing Address - Phone:717-731-1133
Mailing Address - Fax:717-635-8385
Practice Address - Street 1:717 MARKET ST
Practice Address - Street 2:SUITE 101
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1581
Practice Address - Country:US
Practice Address - Phone:717-731-1133
Practice Address - Fax:717-635-8385
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006019213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PADQ1524OtherRAILROAD MEDICARE
PA6364590001Medicare NSC
PA178702Medicare PIN