Provider Demographics
NPI:1598794323
Name:MARK P HOLENCIK
Entity Type:Organization
Organization Name:MARK P HOLENCIK
Other - Org Name:CONSERVATIVE ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:HOLENCIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:717-243-0241
Mailing Address - Street 1:4520 UNION DEPOSIT RD
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17111-2910
Mailing Address - Country:US
Mailing Address - Phone:717-652-6105
Mailing Address - Fax:717-652-2165
Practice Address - Street 1:40 BROOKWOOD AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-9173
Practice Address - Country:US
Practice Address - Phone:717-243-0241
Practice Address - Fax:717-243-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50013888OtherBLUE CROSS
PA20038901Medicaid
PAB36427Medicare UPIN
PA101404Medicare PIN