Provider Demographics
NPI:1508857194
Name:HOLZHAUER, ROBERT G (PA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:HOLZHAUER
Suffix:
Gender:M
Credentials:PA
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 1120
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-1120
Mailing Address - Country:US
Mailing Address - Phone:860-585-3945
Mailing Address - Fax:860-585-3907
Practice Address - Street 1:539 FARMINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3931
Practice Address - Country:US
Practice Address - Phone:860-314-6046
Practice Address - Fax:860-314-6047
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000236363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
A40238Medicare UPIN