Provider Demographics
NPI:1295727105
Name:HOLZER, DONALD (MD)
Entity type:Individual
Prefix:MR
First Name:DONALD
Middle Name:
Last Name:HOLZER
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 1:3315 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-3319
Mailing Address - Country:US
Mailing Address - Phone:757-399-0759
Mailing Address - Fax:757-397-8957
Practice Address - Street 1:3315 HIGH ST
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23707-3319
Practice Address - Country:US
Practice Address - Phone:757-399-0759
Practice Address - Fax:757-397-8957
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012340032084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0500834OtherTRICARE STANDARD
VA7119291Medicaid
150684200OtherOWCP
54-1951442OtherMIDATLANTIC HEALTH SOLUTI
VAP00022532OtherMEDICARE RAILROAD
465352OtherANTHEM
VA0500834OtherPHYSICIAN NETWORK
VA54-1951442OtherHEALTH NETWORK
VA465352OtherBCBS
54-1951442OtherBENESIGHT
6086731015OtherCIGNA
465352OtherHEALTHKEEPERS
465352OtherPENINSULA HEALTHCARE INC
465352OtherPRIORITY HEALTH CARE INC
54-1951442OtherFOCUS
NC89066VYMedicaid
54-1951442OtherCORVEL WC PROVIDER NETWOR
69674OtherSENTRA
VA0500834OtherPHYSICIAN NETWORK
54-1951442OtherMIDATLANTIC HEALTH SOLUTI