Provider Demographics
NPI:1548254873
Name:HOLSOPPLE, TANYA LOHR (DO)
Entity type:Individual
Prefix:
First Name:TANYA
Middle Name:LOHR
Last Name:HOLSOPPLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-2415
Mailing Address - Country:US
Mailing Address - Phone:814-944-8811
Mailing Address - Fax:814-941-8828
Practice Address - Street 1:1400 9TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-2415
Practice Address - Country:US
Practice Address - Phone:814-944-8811
Practice Address - Fax:814-941-8828
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1414149OtherPREFFERED HE AMERIHEALTH
PA68699W420OtherGEISINGER
PA100909198Medicaid
PA28767OtherHEALTH AMERICA HEALTH ASS
PAHO001414149OtherHIGHMARK
PA304946OtherUPMC
PAP00032110OtherRR MEDICARE
PA68699W420OtherGEISINGER
PA1414149OtherPREFFERED HE AMERIHEALTH