Provider Demographics
NPI:1922188556
Name:STANKEWICZ, HOLLY A (DO)
Entity type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:A
Last Name:STANKEWICZ
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:HOLLY
Other - Middle Name:A
Other - Last Name:WALLERICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 1754
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18105-1754
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:CEDAR CREST & I-78
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18105-1556
Practice Address - Country:US
Practice Address - Phone:610-402-8130
Practice Address - Fax:610-360-2725
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS013429207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017506520002OtherPROMISE
PA101750652Medicaid
PA101750652Medicaid