Healthcare Provider Details

I. General information

NPI: 1629283593
Provider Name (Legal Business Name): PATRICIA HARGER HOLTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2007
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 MARYLAND RD SUITE 160
WILLOW GROVE PA
19090-1109
US

IV. Provider business mailing address

2510 MARYLAND RD STE 160 SUITE 160
WILLOW GROVE PA
19090-1137
US

V. Phone/Fax

Practice location:
  • Phone: 215-672-6622
  • Fax: 215-672-6566
Mailing address:
  • Phone: 215-672-6622
  • Fax: 215-672-6566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25 MA074185
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD071410L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: