Healthcare Provider Details

I. General information

NPI: 1902881717
Provider Name (Legal Business Name): DOUGLAS KEITH HOLTZMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 STONEMARK LN STE 100
COLUMBIA SC
29210-3881
US

IV. Provider business mailing address

187 N CHURCH ST STE 201
SPARTANBURG SC
29306-5154
US

V. Phone/Fax

Practice location:
  • Phone: 888-704-4661
  • Fax: 888-239-2595
Mailing address:
  • Phone: 800-932-2738
  • Fax: 888-761-8483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number200200544
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number200200544
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: