Provider Demographics
NPI:1790723443
Name:HOLGADO, IAN DENNIS (DO)
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:DENNIS
Last Name:HOLGADO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:I. DENNIS
Other - Middle Name:
Other - Last Name:HOLGADO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:412 CREAMERY WAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2551
Mailing Address - Country:US
Mailing Address - Phone:610-594-7590
Mailing Address - Fax:610-594-2625
Practice Address - Street 1:93 W DEVON DR
Practice Address - Street 2:SUITE 100
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-3062
Practice Address - Country:US
Practice Address - Phone:610-321-0200
Practice Address - Fax:610-594-2625
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012508207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102434521Medicaid
PA102434521Medicaid
PAI02318Medicare UPIN