MEDICARE: DR. KARL DERIVAS HOLSCHUH MD

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	D20731	MD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	607156001	OTHER	MD	FEDERAL WORKMAN'S COMP
2	61617	OTHER	MD	MAMSI
3	67820	OTHER	MD	UNITED HEALTHCARE
4	0001	OTHER	DC	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	3166605	OTHER	MD	AETNA HMO
7	110980	OTHER	MD	KAISER
8	15123	OTHER	MD	JHHC
9	1800584	OTHER	MD	AMERICHOICE
10	4128365	OTHER	MD	AETNA PPO
11	41526903	OTHER	MD	BCBS

NPI Number	:	1548269343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARL DERIVAS HOLSCHUH MD

Provider Business Mailing Address
First Line	:	PO BOX 64501
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4501
Country	:	US
Telephone Number	:	410-280-6549
Fax Number	:	410-280-6515

Provider Business Practice Location Address
First Line	:	2001 MEDICAL PKWY
Second Line	:	2ND FLOOR DONNER PAVILION
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-3280
Country	:	US
Telephone Number	:	443-481-3300
Fax Number	:	443-481-3315

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	05/12/2008

2001 MEDICAL PARKWAY
ANNAPOLIS, MD
21401-3280

Practice Phone: 443-481-1000
Practice Fax: 443-481-1360

2001 MEDICAL PKWY
ANNAPOLIS, MD
21401-3280