Provider Demographics
NPI:1164603759
Name:HOLLIDAY, NICOLE MARLENE (DO)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:MARLENE
Last Name:HOLLIDAY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-337-4249
Practice Address - Street 1:147 GETTYS ST
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-2534
Practice Address - Country:US
Practice Address - Phone:717-337-4216
Practice Address - Fax:717-337-4249
Is Sole Proprietor?:No
Enumeration Date:2007-11-25
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015219207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102482298Medicaid
PA1589518OtherGATEWAY-WMG
PA2511942OtherHIGHMARK BLUE SHIELD-WMG
PA310452OtherUNISON-WMG
PA30077871OtherAMERIHEALTH MERCY-WMG
PA311595OtherUNITED HEALTHCARE COMM PLAN-YH
PA30080144OtherAMERIHEALTH MERCY-WMG
PA415244OtherUPMC-WMG
PA102482298Medicaid
PA30080144OtherAMERIHEALTH MERCY-WMG
PAP00868737Medicare PIN