Provider Demographics
NPI:1902881717
Name:HOLTZMAN, DOUGLAS KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:KEITH
Last Name:HOLTZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:187 N CHURCH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-5154
Mailing Address - Country:US
Mailing Address - Phone:800-932-2738
Mailing Address - Fax:888-761-8483
Practice Address - Street 1:136 STONEMARK LN STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-3881
Practice Address - Country:US
Practice Address - Phone:888-704-4661
Practice Address - Fax:888-239-2595
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200200544208000000X, 207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131M9Medicaid
SC144472Medicaid
SC144472Medicaid
NC2022945Medicare PIN