Provider Demographics
NPI:1417998212
Name:MITTELHOLZER, ERNEST MICHAEL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:MICHAEL
Last Name:MITTELHOLZER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:50 ASHTON LANE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075
Mailing Address - Country:US
Mailing Address - Phone:413-534-0072
Mailing Address - Fax:413-532-5308
Practice Address - Street 1:575 BEECH ST
Practice Address - Street 2:HOLYOKE MEDICAL CENTER
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040
Practice Address - Country:US
Practice Address - Phone:413-534-2523
Practice Address - Fax:413-532-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA382872085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2041286Medicaid
A38702Medicare UPIN
MA2041286Medicaid