Healthcare Provider Details

I. General information

NPI: 1659400851
Provider Name (Legal Business Name): PEDIATRICS OF NEWBERRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 EXECUTIVE DR
NEWBERRY SC
29108-2952
US

IV. Provider business mailing address

PO BOX 355
NEWBERRY SC
29108-0355
US

V. Phone/Fax

Practice location:
  • Phone: 803-405-0220
  • Fax: 803-405-0222
Mailing address:
  • Phone: 803-405-0220
  • Fax: 803-405-0222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KARL W HOLTZER
Title or Position: OWNER
Credential: M.D.
Phone: 803-405-0220