Healthcare Provider Details

I. General information

NPI: 1053407023
Provider Name (Legal Business Name): FRED JAMIE W HOLLAND II MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 SASSAFRAS ST SUITE 305
ERIE PA
16502-2722
US

IV. Provider business mailing address

3530 PEACH ST SUITE LL1
ERIE PA
16508-2768
US

V. Phone/Fax

Practice location:
  • Phone: 814-456-9197
  • Fax: 814-455-2765
Mailing address:
  • Phone: 814-860-5000
  • Fax: 814-860-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE HOLLAND
Title or Position: CEO
Credential: MD
Phone: 814-456-9197