Healthcare Provider Details

I. General information

NPI: 1417925256
Provider Name (Legal Business Name): ROBERT LEWIS MAHOLIC DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 09/29/2026
Certification Date: 01/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 2ND ST FL 2
ERIE PA
16507-1579
US

IV. Provider business mailing address

120 E 2ND ST FL 2
ERIE PA
16507-1579
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-8980
  • Fax: 814-451-0443
Mailing address:
  • Phone: 814-456-8980
  • Fax: 814-451-0443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number241873-01
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberOS010899L
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number241873-01
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberOS010899L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: