Provider Demographics
NPI:1417938226
Name:HOLT, DAVID ARNOLD (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:ARNOLD
Last Name:HOLT
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:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-2168
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 EAST WOOD ST
Practice Address - Street 2:STE 302
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3040
Practice Address - Country:US
Practice Address - Phone:864-560-6844
Practice Address - Fax:864-560-4413
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC11093207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00360974OtherRR MEDICARE
SC110938Medicaid
SCGP0859Medicaid
SCGP0859Medicaid
SC110938Medicaid
P00360974OtherRR MEDICARE
D05728Medicare UPIN
SCD057284547Medicare ID - Type Unspecified