Doctor Name: | MR. MARK E. HOLTCAMP |
NPI Number: | 1053402057 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | 50000204 |
Business Practice Address: | 2785 Som Center Rd Willoughby, OH - 440949139 |
Business Phone Number: | 4409755575 |
Business Fax Number: | 4409440920 |
Mailing Address: | 2785 Som Center Rd, WILLOUGHBY |
State: | OH |
Postal Code: | 440949139 |
Phone Number: | 4409755575 |
Fax Number: | 4409440920 |
NPI Enumeration Date: | 09/27/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 50000204 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OH |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |