Provider Demographics
NPI:1164817581
Name:HOLUB, MEREDITH SULLIVAN (DO)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:SULLIVAN
Last Name:HOLUB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:SULLIVAN
Other - Last Name:LOH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:85 SEYMOUR ST STE 923
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5529
Mailing Address - Country:US
Mailing Address - Phone:860-524-4550
Mailing Address - Fax:
Practice Address - Street 1:85 SEYMOUR ST STE 923
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5529
Practice Address - Country:US
Practice Address - Phone:860-524-4550
Practice Address - Fax:860-524-4465
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT67818207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program