Provider Demographics
NPI:1407984180
Name:HOLT, STEPHEN R (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:HOLT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:150 SARGENT DR
Mailing Address - Street 2:STE 1-200
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6100
Mailing Address - Country:US
Mailing Address - Phone:203-789-4094
Mailing Address - Fax:
Practice Address - Street 1:1450 CHAPEL ST
Practice Address - Street 2:ADULT PRIMARY CARE CLINIC
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-4405
Practice Address - Country:US
Practice Address - Phone:203-789-4094
Practice Address - Fax:203-789-3007
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2020-12-23
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Provider Licenses
StateLicense IDTaxonomies
CT044493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI73168Medicare UPIN