Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | MD012316E | PA |
N | 2080P0214X | Pediatric Pulmonologist | MD012316E | PA |
NPI | 1629037437 |
---|---|
Provider Name | Douglas Stanley Holsclaw JR. |
First Address | Bala Cynwyd, PA 19004-2403 |
Second Address | Bala Cynwyd, PA 19004-2403 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 18/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0006732510013 | (05) | PA |
099759 | BLUE SHIELD (01) | PA |