Provider Demographics
NPI:1760409734
Name:HOLMAN, INGRID AALTJE-ATJE (MD)
Entity Type:Individual
Prefix:DR
First Name:INGRID
Middle Name:AALTJE-ATJE
Last Name:HOLMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:999 WEIGLES HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:PA
Mailing Address - Zip Code:15037-2135
Mailing Address - Country:US
Mailing Address - Phone:412-384-1721
Mailing Address - Fax:412-384-5328
Practice Address - Street 1:1001 WEIGLES HILL RD
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:PA
Practice Address - Zip Code:15037-2137
Practice Address - Country:US
Practice Address - Phone:412-384-8070
Practice Address - Fax:412-384-3008
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD038699L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0806349Medicaid
PA0806349Medicaid
PAAH9529201OtherDEA REGISTRATION NUMBER
PAB41345Medicare UPIN