Provider Demographics
NPI:1427026319
Name:HOLUBOWITCH, EDWARD JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:HOLUBOWITCH
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 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-872-7536
Mailing Address - Fax:520-872-7929
Practice Address - Street 1:400 W CAMINO CASA VERDE
Practice Address - Street 2:#100
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-3564
Practice Address - Country:US
Practice Address - Phone:520-625-1760
Practice Address - Fax:520-648-1394
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101036227207Q00000X
AZ45484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0103774OtherUNITED HEALTHCARE PROVIDE
VA466797OtherANTHEM PROVIDER NUMBER
AZ671649Medicaid
VA005629250Medicaid
VA101808OtherCIGNA PROVIDER NUMBER
VA79292OtherSOUTHERN HEALTH PROVIDER
VACB1505OtherRAILROAD MEDICARE GROUP #
VA466796OtherANTHEM GROUP NUMBER
VA005629250OtherVIRGINIA PREMIER PROVIDER
VA0164ROtherBCBS OF NC COSTWISE
VA080018162OtherRAILROAD MEDICARE PROVIDE
VA2129327OtherMAMSI PROVIDER NUMBER
VA466797OtherANTHEM PROVIDER NUMBER
VA0164ROtherBCBS OF NC COSTWISE
VA005629250OtherVIRGINIA PREMIER PROVIDER