Provider Demographics
NPI:1912988833
Name:HOLDAWAY, PETER JOSEPH (DPM)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:HOLDAWAY
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 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-264-5211
Mailing Address - Fax:717-264-5418
Practice Address - Street 1:1920 SCOTLAND AVE
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-1450
Practice Address - Country:US
Practice Address - Phone:717-264-5211
Practice Address - Fax:717-264-5418
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDMD01269213E00000X
PASC003622L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012553Medicaid
PA103136097Medicaid
PA80007Medicaid
PA103136097Medicaid
PA0680032QHTMedicare ID - Type Unspecified