Provider Demographics
NPI:1205829983
Name:HOLTZ, PETER S (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:HOLTZ
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: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
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2010-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000616213E00000X
PASC006019213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACG4514OtherMEDICARE RAILROAD
PA102414841Medicaid
PAP00818686OtherRAILROAD MEDICARE
VACG4514OtherMEDICARE RAILROAD
VAT21600Medicare UPIN
PA6364590001Medicare NSC
PA178701YAKCMedicare PIN
WV0601822Medicare PIN