Provider Demographics
NPI:1750378808
Name:HOLMAN, DAVID CHARLES (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHARLES
Last Name:HOLMAN
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 1:101 E CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:MIFFLINBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17844-9607
Mailing Address - Country:US
Mailing Address - Phone:570-966-3155
Mailing Address - Fax:570-966-6901
Practice Address - Street 1:101 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:MIFFLINBURG
Practice Address - State:PA
Practice Address - Zip Code:17844-9607
Practice Address - Country:US
Practice Address - Phone:570-966-3155
Practice Address - Fax:570-966-6901
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002738L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0010047840001Medicaid
PA01522701OtherCAPITAL BCBS
PA01522701OtherCAPITAL BCBS
89697Medicare ID - Type Unspecified