Provider Demographics
NPI:1194782540
Name:HOLDAWAY, DIANE M (DPM)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:HOLDAWAY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:524 FERN LN
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17202-8098
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:717-217-4218
Practice Address - Street 1:524 FERN LN
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17202-8098
Practice Address - Country:US
Practice Address - Phone:717-217-4218
Practice Address - Fax:717-217-4218
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2017-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003504L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0672222Medicare ID - Type Unspecified
PAU17691Medicare UPIN