Provider Demographics
NPI:1144235433
Name:HOLZER, JACOB C (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:C
Last Name:HOLZER
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:WESTBOROUGH STATE HOSPITAL
Mailing Address - Street 2:288 LYMAN ST
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-616-2525
Mailing Address - Fax:
Practice Address - Street 1:WESTBOROUGH STATE HOSPITAL
Practice Address - Street 2:288 LYMAN ST
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-616-2525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA742582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry