Healthcare Provider Details

I. General information

NPI: 1295727105
Provider Name (Legal Business Name): DONALD HOLZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 HIGH ST
PORTSMOUTH VA
23707-3319
US

IV. Provider business mailing address

3315 HIGH ST
PORTSMOUTH VA
23707-3319
US

V. Phone/Fax

Practice location:
  • Phone: 757-399-0759
  • Fax: 757-397-8957
Mailing address:
  • Phone: 757-399-0759
  • Fax: 757-397-8957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number0101234003
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: