Provider Demographics
NPI:1558467209
Name:SJOHOLM, LARS OLA I (MD)
Entity Type:Individual
Prefix:DR
First Name:LARS OLA
Middle Name:I
Last Name:SJOHOLM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 S STRATFORD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5908
Mailing Address - Country:US
Mailing Address - Phone:805-332-8446
Mailing Address - Fax:805-332-8173
Practice Address - Street 1:316 S STRATFORD AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-332-8446
Practice Address - Fax:805-332-8173
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC1778182086S0102X, 2086S0102X
PAMD4357062086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0002181OtherAETNA
PA2078341OtherHIGHMARK BLUE SHIELD
NJ2623781OtherUNITED HEALTHCARE
NJ0095087Medicaid
2684555000OtherBLUE SHIELD KEYSTONE AMERIHEALTH
NJ3K6094OtherHEALTNET
NJP00292748OtherRR MEDICARE
NJ91001907400OtherAMERICHOICE
NJ60021848OtherHORIZON NJ HEALTH
NJ1134057OtherAETNA
NJ098743 SH7Medicare PIN
PA0002181OtherAETNA
NJ91001907400OtherAMERICHOICE
I49956Medicare UPIN