Provider Demographics
NPI:1336139849
Name:HOLT, CRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:HOLT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 GOVERNORS AVE STE 256
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02155-1643
Mailing Address - Country:US
Mailing Address - Phone:781-393-4448
Mailing Address - Fax:781-306-6475
Practice Address - Street 1:170 GOVERNORS AVE STE 256
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-1643
Practice Address - Country:US
Practice Address - Phone:781-393-4448
Practice Address - Fax:781-306-6475
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA150421207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1211382Medicaid
MAA22575Medicare ID - Type Unspecified
MA1211382Medicaid