Provider Demographics
NPI:1447224845
Name:HOLLEN, CHARLES R (MD)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:R
Last Name:HOLLEN
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 1:3333 CATTLEMEN RD STE 208
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-6058
Mailing Address - Country:US
Mailing Address - Phone:941-379-5121
Mailing Address - Fax:941-379-4239
Practice Address - Street 1:3333 CATTLEMEN RD STE 208
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-6058
Practice Address - Country:US
Practice Address - Phone:941-379-5121
Practice Address - Fax:941-379-4239
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME354369207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65496500Medicaid
D54718Medicare UPIN
FL41181VMedicare PIN