Provider Demographics
NPI:1669520995
Name:HOLIK, JOSEPH LEONARD (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:LEONARD
Last Name:HOLIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:J
Other - Middle Name:L
Other - Last Name:HOLIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:51 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2045
Mailing Address - Country:US
Mailing Address - Phone:413-584-6810
Mailing Address - Fax:413-587-0495
Practice Address - Street 1:51 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2045
Practice Address - Country:US
Practice Address - Phone:413-584-6810
Practice Address - Fax:413-587-0495
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA57304208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2039737Medicaid
MA2039737Medicaid
MAK08278Medicare ID - Type Unspecified