Provider Demographics
NPI:1083680284
Name:HOLT, CHARLES ALLEN (DO)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:ALLEN
Last Name:HOLT
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:845 WILLIAMS COVE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5343
Mailing Address - Country:US
Mailing Address - Phone:317-255-7446
Mailing Address - Fax:317-554-0193
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:1481 WEST 10TH STREET
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0000
Practice Address - Fax:317-988-5359
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
IN02000982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine