Provider Demographics
NPI:1295846145
Name:HOLLAND, ROBERT R (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:HOLLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:189 PROUTY DR
Mailing Address - Street 2:EMERGENCY DEPT
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-9326
Mailing Address - Country:US
Mailing Address - Phone:802-334-4111
Mailing Address - Fax:802-334-3281
Practice Address - Street 1:189 PROUTY DR
Practice Address - Street 2:EMERGENCY DEPT
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9326
Practice Address - Country:US
Practice Address - Phone:802-334-4111
Practice Address - Fax:802-334-3281
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VT0420005067207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0005011Medicaid
VT00005011OtherBLUE SHIELD
VTVT5011Medicare ID - Type Unspecified
VT0005011Medicaid