Provider Demographics
NPI:1194754606
Name:HOLTERMAN, ROBERT K (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:K
Last Name:HOLTERMAN
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:PO BOX 10730
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0730
Mailing Address - Country:US
Mailing Address - Phone:562-809-3548
Mailing Address - Fax:562-468-0726
Practice Address - Street 1:315 S MANNING BLVD
Practice Address - Street 2:@ ST. PETER'S HOSPITAL ER DEPT.
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1707
Practice Address - Country:US
Practice Address - Phone:518-525-1324
Practice Address - Fax:518-383-4223
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY183556-1207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01831227Medicaid
NYB41971Medicare UPIN
NYDD3539Medicare ID - Type UnspecifiedINDV. PROVIDER #FOR GROUP
NY01831227Medicaid