Provider Demographics
NPI:1467445429
Name:HOLLER, MATTHEW B (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:B
Last Name:HOLLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8500
Mailing Address - Country:US
Mailing Address - Phone:910-715-1010
Mailing Address - Fax:910-715-1026
Practice Address - Street 1:155 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8710
Practice Address - Country:US
Practice Address - Phone:910-715-2164
Practice Address - Fax:910-715-4493
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200601784208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00364847OtherPALMETTO GOVT SERVICES
SCN01784OtherSC MEDICAID
NC89066MRMedicaid
NC194239OtherMEDCOST PROVIDER #
NC144APOtherBCBS
NCFH1100185OtherFIRSTCAROLINA
NC194239OtherMEDCOST PROVIDER #
NCP00364847OtherPALMETTO GOVT SERVICES