Provider Demographics
NPI:1457307852
Name:HOLMBERG, ROBERT E JR (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:HOLMBERG
Suffix:JR
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 JONES POINT RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04617-3570
Mailing Address - Country:US
Mailing Address - Phone:207-326-0916
Mailing Address - Fax:
Practice Address - Street 1:110 JONES POINT RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:ME
Practice Address - Zip Code:04617-3570
Practice Address - Country:US
Practice Address - Phone:207-326-0916
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD9178208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM241102Medicare PIN
MED88011Medicare UPIN
MEMM2411Medicare PIN