Provider Demographics
NPI:1245611201
Name:HOLDEN, REGIS (PA-C)
Entity Type:Individual
Prefix:
First Name:REGIS
Middle Name:
Last Name:HOLDEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2580 HAYMAKER RD STE 104
Mailing Address - Street 2:
Mailing Address - City:MONROEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15146-3500
Mailing Address - Country:US
Mailing Address - Phone:412-373-1600
Mailing Address - Fax:412-373-4197
Practice Address - Street 1:2580 HAYMAKER RD STE 104
Practice Address - Street 2:
Practice Address - City:MONROEVILLE
Practice Address - State:PA
Practice Address - Zip Code:15146-3500
Practice Address - Country:US
Practice Address - Phone:412-373-1600
Practice Address - Fax:412-373-4197
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA057391363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
13705730OtherCAQH