Provider Demographics
NPI:1760541528
Name:HOLGADO, MARCO PAUL (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARCO
Middle Name:PAUL
Last Name:HOLGADO
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1177 S GOVERNORS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-6903
Mailing Address - Country:US
Mailing Address - Phone:302-678-4612
Mailing Address - Fax:302-678-4614
Practice Address - Street 1:1177 S GOVERNORS AVE STE B
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-6903
Practice Address - Country:US
Practice Address - Phone:302-678-4612
Practice Address - Fax:302-678-4614
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-07
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000139213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEG02537F01Medicare PIN
DE5930460001Medicare NSC
DEU78794Medicare UPIN