Provider Demographics
NPI:1376701912
Name:HOLLER, PHILLIP D (MD)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:D
Last Name:HOLLER
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 1:3400 CIVIC CENTER BLVD.
Mailing Address - Street 2:1-330S PERELMAN CENTER
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104
Mailing Address - Country:US
Mailing Address - Phone:215-662-2737
Mailing Address - Fax:215-615-3424
Practice Address - Street 1:3400 CIVIC CENTER BLVD.
Practice Address - Street 2:1-330S PERELMAN CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-2737
Practice Address - Fax:215-615-3424
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD445582207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology