Provider Demographics
NPI:1548269343
Name:HOLSCHUH, KARL DERIVAS (MD)
Entity type:Individual
Prefix:DR
First Name:KARL
Middle Name:DERIVAS
Last Name:HOLSCHUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64501
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4501
Mailing Address - Country:US
Mailing Address - Phone:410-280-6549
Mailing Address - Fax:410-280-6515
Practice Address - Street 1:2001 MEDICAL PKWY
Practice Address - Street 2:2ND FLOOR DONNER PAVILION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-3300
Practice Address - Fax:443-481-3315
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD20731208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD607156001OtherFEDERAL WORKMAN'S COMP
MD61617OtherMAMSI
MD67820OtherUNITED HEALTHCARE
DC0001OtherBCBS
MD265321400Medicaid
MD3166605OtherAETNA HMO
MD110980OtherKAISER
MD15123OtherJHHC
MD1800584OtherAMERICHOICE
MD4128365OtherAETNA PPO
MD41526903OtherBCBS
MD265321400Medicaid
MD607156001OtherFEDERAL WORKMAN'S COMP