MEDICARE: DR. DOUGLAS KEITH HOLTZMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	200200544	NC
2	207PP0204X	Pediatric Emergency Medicine (Emergency Medicine) Physician	200200544	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1902881717
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS KEITH HOLTZMAN MD

Provider Business Mailing Address
First Line	:	187 N CHURCH ST STE 201
Second Line	:
City	:	SPARTANBURG
State	:	SC
Zip	:	29306-5154
Country	:	US
Telephone Number	:	800-932-2738
Fax Number	:	888-761-8483

Provider Business Practice Location Address
First Line	:	136 STONEMARK LN STE 100
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-3881
Country	:	US
Telephone Number	:	888-704-4661
Fax Number	:	888-239-2595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	10/10/2025

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