Provider Demographics
NPI:1053407023
Name:FRED JAMIE W HOLLAND II MD PC
Entity type:Organization
Organization Name:FRED JAMIE W HOLLAND II MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-456-9197
Mailing Address - Street 1:3530 PEACH ST
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2768
Mailing Address - Country:US
Mailing Address - Phone:814-860-5000
Mailing Address - Fax:814-860-5050
Practice Address - Street 1:2314 SASSAFRAS ST
Practice Address - Street 2:SUITE 305
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2722
Practice Address - Country:US
Practice Address - Phone:814-456-9197
Practice Address - Fax:814-455-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1014522940002Medicaid
PA1014522940002Medicaid