Provider Demographics
NPI:1023018587
Name:HOLTZMAN, LORI RAE (MD)
Entity type:Individual
Prefix:DR
First Name:LORI
Middle Name:RAE
Last Name:HOLTZMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 381442
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38183-1442
Mailing Address - Country:US
Mailing Address - Phone:901-350-2639
Mailing Address - Fax:901-249-4563
Practice Address - Street 1:2565 HORIZON LAKE DR STE 114
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8113
Practice Address - Country:US
Practice Address - Phone:901-350-2639
Practice Address - Fax:901-249-4563
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN31899207PP0204X, 208000000X
TNTNMD31899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121309Medicaid
TN3496002Medicaid
TN103I372860Medicare PIN