Provider Demographics
NPI:1215907084
Name:HOLTZ, DAVID O (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:O
Last Name:HOLTZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:100 E LANCASTER AVE
Mailing Address - Street 2:661 LANKENAU MOB EAST
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-3450
Mailing Address - Country:US
Mailing Address - Phone:610-649-8085
Mailing Address - Fax:610-649-8984
Practice Address - Street 1:100 E LANCASTER AVE
Practice Address - Street 2:661 LANKENAU MOB EAST
Practice Address - City:WYNNEWOOD
Practice Address - State:PA
Practice Address - Zip Code:19096-3450
Practice Address - Country:US
Practice Address - Phone:610-649-8085
Practice Address - Fax:610-649-8984
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD072161L207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I26576Medicare UPIN
PA089083HK1Medicare PIN
PA101236191Medicaid
PW232359401OtherMAIN LINE HEALTHCARE