Provider Demographics
NPI:1447398805
Name:HOLMBLAD, CHRISTIAN J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:J
Last Name:HOLMBLAD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:116 BELMONT ST
Mailing Address - Street 2:STE. 11
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-2964
Mailing Address - Country:US
Mailing Address - Phone:508-754-8500
Mailing Address - Fax:508-754-7044
Practice Address - Street 1:3601 SW 160TH AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-6308
Practice Address - Country:US
Practice Address - Phone:877-866-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2015-07-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA0535292086S0129X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB97902Medicare UPIN