Provider Demographics
NPI:1891750360
Name:HOLZDEPFEL, JONATHAN LEE (MD)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:LEE
Last Name:HOLZDEPFEL
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 1:29 LAUREL LANE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:NH
Mailing Address - Zip Code:03854
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:150 ROUTE 1 BYPASS
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-5332
Practice Address - Country:US
Practice Address - Phone:603-431-1121
Practice Address - Fax:603-431-3347
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH6067207X00000X
ME009855207X00000X
MI0720966207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH82206909Medicaid
NH82206909Medicaid
B86140Medicare UPIN